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COPYRIGHT DEPOSIT. 



Mother and Child 



by 



EDWARD P. DAVIS, A.M., M.D. 
* » 

PROFESSOR OF OBSTETRICS IN THE JEFFERSON MEDICAL COLLEGE J PROFESSOR 

OF OBSTETRICS AND DISEASES OF INFANCY IN THE PHILADELPHIA 

POLYCLINIC ; VISITING OBSTETRICIAN TO THE JEFFERSON, 

PHILADELPHIA, AND POLYCLINIC HOSPITALS, ETC. 




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PHILADELPHIA 

J. B. LIPPINCOTT COMPANY 
1902 



THE LIBRARY OF 

CONGRESS, 
Two Copies Received 

iUL. 5 1902 

»KJMT ENTWV 

°^XXa Wo. 

3 k a / *f 

COPY B. 






Copyright, 1902, 
By J. B. Lippincott Company. 



ELECTHOTYPID AND PRINTED BY J. B. LIPPINCOTT COMPANY, PHILADELPHIA, U.S.A. 



PREFACE. 



The request of the publishers to prepare a 
second edition of this book brings freshly to 
our remembrance our loss sustained in the 
death of Dr. John M. Keating. It was the 
writer's privilege to be associated with him in 
the preparation of the first edition. This 
edition has been remodelled in accordance 
with the various changes which time has 
brought about in the department of medicine 
of which it treats. The plan originally adopted 
and carried out through many of Dr. Keat- 
ing' s suggestions has been followed in the 
preparation of this edition. 

The writer's acknowledgments are due to 
his nurses, from whose practical experience 
much valuable material has been obtained. 
To Miss Ellen V. Hayes, Chief Nurse of the 
Jefferson Maternity, and to Miss S. J. Martin, 
his thanks are due for the preparation of the 

3 



4 PREFACE. 

illustrations ; to Miss M. E. Smith, Chief 
Nurse of the Philadelphia Hospital, he is 
indebted for formulae used in the hospital ; 
and to Miss Mary A. Nick, from whom he 
obtained recipes for the preparation of gruels, 
jellies, and purees. The Dietary of the Jef- 
ferson Hospital has also supplied some useful 
recipes. 

No. 250 South Twenty-first Street, 
Philadelphia, June, 1902. 



INTRODUCTION. 



This book is not intended to supply pre- 
scriptions for medicines nor to take the place 
of the family physician. It is designed to 
help him in the care of his patients by placing 
at their disposal information which physicians 
commonly give to their patients. The physi- 
cal prosperity of mothers and children is so 
largely dependent upon the faithful observance 
of simple precautions, that anything which 
gives information regarding this care cannot 
fail to be useful. The form of the present 
edition of the book has been largely suggested 
to the writer by the needs of his own practice 
and embraces much of the advice which he 
usually gives to his patients. 



CONTENTS. 



PART I.— THE MOTHER. 

CHAPTER I. 

PREGNANCY. 

PAGB 

Conception 17 

Signs and Symptoms of Pregnancy 18 

Duration of Pregnancy 20 

A Successful Pregnancy 21 

The Dangers of Pregnancy 23 

The Discomforts of Pregnancy 24 

CHAPTER II. 

THE HYGIENE OF PREGNANCY. 

Food 25 

Nausea and Vomiting 27 

Beverages 27 

Clothing 29 

Exercise 33 

Sleep 34 

Baths and Bathing 35 

Constipation 35 

The Teeth 37 

The Skin 38 

Nervous Disturbances 39 

Medical Advice During Pregnancy 40 

CHAPTER III. 

THE UNBORN CHILD. 

Its Shape and Development 41 

The Determination of Sex 43 

Transmitted Traits and Resemblances 44 

7 



8 CONTENTS. 

PAGE 

A Healthy Development of the Unborn Child 44 

A Healthy Nervous System for the Child 45 

CHAPTER IV. 

HOW SHALL THE PRINCIPAL DANGERS OF PREGNANCY 
BE AVOIDED? 

Abortion or Miscarriage 47 

The Toxaemia of Pregnancy 49 

Symptoms to be Invariably Reported to the Physician. . 51 

CHAPTER V. 

THE END OF PREGNANCY. 

The Nurse . 53 

The Room 54 

The Bed 55 

Medical Supplies 55 

Dressings 56 

Dangerous Articles 58 

CHAPTER VI. 

LABOR. 

Preparations for Labor 59 

Essentials to the Conduct of Labor 60 

CHAPTER VII. 

OBSTETRIC OPERATIONS. 

Operations which Remove the Child 62 

Operations for the Repair of Injuries 63 

CHAPTER VIII. 

THE PUERPERAL OR LYING-IN PERIOD. 

Essentials for Good Recovery 64 

Lactation 68 

When and How Shall the Child Nurse? 70 

Care of the Breasts 7* 



CONTENTS- 9 

PAGE 

Caked Breasts 72 

Sore Nipples 75 

Inflammation of the Breasts 76 

CHAPTER IX. 

COMPLETE RECOVERY FROM CHILDBIRTH. 

Sitting Up 78 

Getting Back the Figure 78 

CHAPTER X. 

HOW LONG SHALL THE MOTHER NURSE THE CHILD? — 
SUCCESSFUL NURSING. 

Diet 81 

Exercise 83 

Constipation 83 

The Child's Weight 84 

Influence of Nursing Upon the Mother's Health 85 



PART H.— THE CHILD. 

CHAPTER I. 

THE CRADLE. 

The Crib 88 

Other Receptacles for an Infant 89 

Shall the Child Remain with the Mother ? 90 

CHAPTER II. 

THE CHILD'S CLOTHING. 

CHAPTER III. 

THE CHILD'S FOOD. 

Formation of Milk 95 

Human Milk and that of Other Animals 97 



io CONTENTS. 

PACK 

When Shall the Child Take its Food ? 98 

How Much Milk Shall the Child Take? 99 

Regurgitation and Vomiting 100 

The Curd of Regurgitated Milk 100 

Vomiting 101 

The Curd of Vomited Milk 101 

Too Rapid Nursing 102 

Feeble Nursing 102 

Shall the Child be Wakened to be Fed ? 103 

Importance of Regularity 104 



CHAPTER IV. 

ARTIFICIAL FEEDING. 

Wet-Nurses 106 

Cow's Milk 106 

Cow-stables, Barns, and Pasture 107 

The Care of Milk 107 

Laboratory Modification 109 

Home Modification of Milk 109 

Pasteurizing and Sterilizing in 

Asepsis in the care of Milk 113 

Mixed Feeding 116 

Feeding as Children Grow Older 116 

Bread 117 

Gruels and Jellies 118 

Broths and Soups 118 

Beef Juice 119 

Purees 120 

Junket and Custards 120 

Eggs 121 

Meat for Young Children 121 

Fruits 121 

Sweets T. 122 

Beverages for Children 123 

Solid Food 123 

Conditions which Favor a Child's Nutrition 124 

Personal Influence in Nourishing Children 127 



CONTENTS. n 

CHAPTER V. 

AIR AND EXERCISE. 

PAGE 

Catching Cold 129 

Exchanging Diseases 130 

Heat and Cold 130 

How Shall the Child go Out ? 131 

Where Should the Child Go ? 132 

Airing In-Doors 133 

Sleeping in the Open Air 134 

A Little Child's Exercise 135 

Exercise with Toys 136 

CHAPTER VI. 

THE NURSERY. 

Ventilating and Warming the Nursery 140 

Nursery Furniture and Utensils 142 

The Location of a' Nursery 143 

Nursery Education 144 

Nursery-Maids 146 

Nursery-Governesses 148 

The Manners of the Nursery 149 

CHAPTER VII. 

THE HEALTHY CHILD. 

Color 151 

The Flesh 152 

The Eyes 152 

The Mouth 152 

The Tongue 153 

Tongue-Tie 153 

The Nose 153 

The Abdomen 154 

The Genital Organs 154 

The Back 154 

The Limbs 155 

Posture and Attitude 155 

Motions 156 



12 CONTENTS. 

PAGE 

Nursing 157 

Swallowing 157 

Sleep 157 

Bowel Movements 158 

Urine 158 

Weight 158 

Correct Scales 160 

Conditions Influencing the Weight of a Child 161 

Weight at Birth 161 

Length 162 

Dentition 162 

The Second or Permanent Teeth 164 

Dentition and Development 164 

Indications for the Care of Children in the Various 

Periods of Development 165 

Beginning a Mixed Diet 165 

CHAPTER VIII. 

THE CARE OF THE CHILD DURING ITS CRISES OF 
DEVELOPMENT. 

The Care of the Child During Dentition 167 

Beginning to Walk 169 

The Development of the Senses 170 

The Airing of the Child 172 

Puberty 173 

Education During Crises of Development 174 

Moral Development During Crises of Growth 176 

CHAPTER IX. 

THE SIGNS OF ILLNESS IN CHILDREN. 

Color of the Skin 178 

Eruptions 178 

Eruptions Caused by Parasites 179 

Chronic Eruptions 180 

Fever 180 

The Pulse and Heart Action 181 

The Breathing in Health and Disease 181 

Vomiting 182 



CONTENTS. 13 

PAGK 

Diarrhoea and Constipation 182 

The Character of Bowel Movements 183 

The Urine 183 

The Child's Expressions of Disease 184 

The Signs of Chronic Disease 185 

CHAPTER X. 

NURSING SICK CHILDREN. 

Shall the Mother Nurse the Child? 186 

Nursing in Diseases of the Digestive Tract 188 

Nursing in Diseases of the Respiratory Organs . . . v . . . 190 

Nursing in Diseases of the Nervous System 194 

The Nursing of Chronic Diseases 195 

CHAPTER XL 

INFECTIOUS AND CONTAGIOUS DISEASES. 

Shall Children be Deliberately Exposed to Infection and 

Contagion ? 196 

Methods by which Contagion and Infection are Con- 
veyed 197 

The Avoidance of Infection and Contagion 199 

The Symptoms of Infection and Contagion 199 

The Eruptions from Infection or Contagion 200 

Isolation 201 

General Nursing in Infectious Cases 202 

CHAPTER XII. 

THE CONVEYANCE OF CONTAGION AND INFECTION. 

Disinfection of the Patient 205 

Disinfection of Clothing, Bedding, Utensils, etc 207 

CHAPTER XIII. 

MEDICAL EMERGENCIES. , 

Poisoning 210 

Prevention of Poisoning 214 

Acids and Alkalies 215 

Convulsions 216 

Heat-Stroke 217 



14 CONTENTS. 

PAGE 

Nose-Bleed 218 

Prolapse of the Intestine 219 

CHAPTER XIV. 

SURGICAL EMERGENCIES. 

Cuts 221 

Burns 222 

Falls, Fractures, and Sprains 225 

Setting an Injured Limb 227 

Foreign Bodies in the Air-Passages 227 

Foreign JBodies in the Eye 228 

Foreign Bodies in the Ear 229 

Earache 233 

Foreign Bodies in the Nose 233 

Foreign Bodies Swallowed by Accident 234 

Foreign Bodies in the Bowel or Bladder 236 

CHAPTER XV. 

EXTERNAL APPLICATIONS. 

The Application of Cold 237 

The Application of Heat 239 

Baths ; 241 

Baths for Medicinal Purposes 242 

Counter-Irritation 243 

Injections 245 

The Destruction of Intestinal Parasites by Injection . .. 247 

CHAPTER XVI. 

ASEPSIS AND ANTISEPSIS. 

Asepsis 250 

Antisepsis 250 

CHAPTER XVII. 

INOCULATION. 

Vaccination 252 

Dietary 256 



ILLUSTRATIONS. 



FIG. PAGE 

Frontispiece to Part 1 17 

1. Incubator containing a prematurely born infant. 

The child has been bandaged with cotton, applied 
with cheese-cloth bandages, instead of the usual 
dress . . 43 

2. Incubator improvised with clothes-basket, blankets, 

and hot- water cans 43 

Frontispiece to Part II 87 

3. Bassinette 88 

4. Showing infant dressed in socks, diaper, and knitted 

band before long-sleeved undershirt is worn .... 91 

5. Another view of dress shown in Fig. 4, usually worn 

under long-sleeved flannel slip in the first weeks 

of infancy 92 

6. Baby with socks, diaper, knitted band, and under- 

shirt, with high neck and long sleeves. Buttoned 
down the front 92 

7. Convenient night-clothes with feet. Suitable for 

child after earliest infancy 92 

8. Long flannel skirt, fastened by buttons on shoulders. 

No sleeves. Worn with high-necked and long- 
sleeved undershirt 92 

9. White muslin petticoat, coming from shoulders. 

Worn over flannel slip. Only necessary under 
fine muslin dresses. Makes too many garments 
on very young baby 92 

10. Another view of petticoat shown in Fig. 9 92 

11. Child fully dressed with simple white nainsook dress, 

trimmed with lace edging; very simply but beau- 
tifully made 93 

15 



1 6 ILLUSTRATIONS. 

FIG - PAGE 

12. View of long white nainsook dress. Baby fully 

dressed 03 

13. Baby dressed to go out, with sensible cloak with 

capes, and cap with very little trimming, with 
wadded silk cap underneath white muslin one 93 

14. Model of best shoe for child's foot,— narrow heel, 

broad toe. For child not walking, buttoned shoe 
is most easily put on. After a child begins to 
walk, the laced shoe is better, with the same 
model, — narrow heel and broad toe 94 

15. Arnold sterilizer 112 

16. Interior of Arnold sterilizer 113 

17. Abdominal massage: rubbing up the child's body 

along the course of the ascending bowel 135 

18. Abdominal massage: rubbing down the child's body 

along the course of the descending bowel ...... 135 

19. Dentition 163 

20. Irrigating the bowel 189 

21. Crib made into a tent by blankets and poles, and 

croup kettle in position 192 

22. Formaldehyde lamp prepared for disinfecting a 

room. The lamp stands upon bricks placed in 

a large pan containing several inches of water . . . 208 

23. A blanket splint applied to a child's thigh and leg . . 226 

24. Douching an inflamed eye with antiseptic solution. 

The affected eye is the left or lower one 230 

25. Baby in bath. Showing most convenient arrange- 

ment of soap, powder, cotton sponges, brush, and 
all necessaries for the toilet. Screen behind nurse 
to keep off any possible draught. Screen also 
useful for hanging long petticoats, dress, etc 241 

26. Rubber bath-tub 242 



MOTHER AND CHILD 



PART I.— THE MOTHER. 



CHAPTER I. 

PREGNANCY. 

Conception. 

In order to comprehend clearly the method 
of reckoning the duration of pregnancy, the 
relation between menstruation and ovulation 
must be understood. Ovulation, or the forma- 
tion of ova by the ovaries, is independent of 
menstruation. Conception may occur at any 
time during the active physical life of woman. 
Cases are sometimes seen in which menstrua- 
tion has been absent for months, but in which 
conception occurred. It is also possible for a 
woman to conceive while nursing a child and 
for menstruation to be continually absent for 
a number of years. Conception is most apt 
to occur either before or after the usual time 

2 17 



1 8 MOTHER AND CHILD. 

for menstruation. If the month be reckoned 
at thirty days between menstrual periods, the 
ten days immediately preceding menstruation 
and the ten days immediately following the 
time when it occurred or should have occurred 
are the most favorable periods for conception. 
As menstruation occurs in most patients, it 
affords the only basis which we have for com- 
puting the duration of pregnancy. 

The conditions which favor the occurrence 
of conception are in many cases obscure. 
General good health is often not present in 
women who bear children frequently. Re- 
covery from severe illness seems in some cases 
to make the patient more liable to conception. 
The fecundity of the poor shows that luxury 
is not a requisite for fertility. Unfortunately, 
the drunken and vicious bear children much 
too frequently. In general, sound health and 
a life as normal as surroundings will permit 
favor healthful pregnancy, and abnormal con- 
ditions do not conduce to healthful conception. 

Signs and Symptoms of Pregnancy. 

Pregnancy may exist for several weeks and 
occasionally for several months without signs 
or symptoms. Some time is required for the 
passage of the impregnated ovum to the 



THE MOTHER. i 9 

uterus, and during this time there is no physi- 
cal evidence of pregnancy. After the ovum 
reaches the womb the uterus commences to 
enlarge very gradually, and several weeks 
may pass before sufficient change has occurred 
in the uterus to make a diagnosis possible. 
In complicated cases a positive diagnosis can- 
not be made until seven months have elapsed, 
and in cases where pregnancy exists in patients 
having tumors it may never be suspected. 
From these facts it follows that the patient 
may not receive a positive statement from her 
physician regarding the existence of pregnancy 
for some time after she suspects it herself. In 
most cases, within the first ten weeks after the 
last menstruation, the physician can state that 
in all probability pregnancy is present or is 
absent. 

The most usual symptoms of pregnancy are 
cessation of or very much diminished menstru- 
ation, nausea and vomiting in the morning, 
enlargement of the breasts, often with tingling 
sensations or shooting pains, enlargement of 
the neck, gradual enlargement of the abdo- 
men, and disorders of digestion. These, how- 
ever, may all be present and the patient be 
positive that she is pregnant when no real 
pregnancy exists. Only a physician can posi- 



20 MOTHER AND CHILD. 

tively determine the presence or absence of 
pregnancy. 

Where pregnancy is really present, nausea 
and vomiting gradually cease, the abdomen 
steadily enlarges, the movements of the child 
are recognized, milk gradually forms in the 
breasts, and by examination the presence of 
the child and its position in the mother's 
womb may be ascertained. 

Duration of Pregnancy. 

There is no fixed limit to the duration of 
pregnancy. The average is from two hundred 
and seventy to two hundred and eighty days. 
Cases are sometimes seen in which the preg- 
nancy lasts three hundred days and more. A 
child has been born at twenty-six weeks preg- 
nancy and has survived. There are several 
reasons for the inability to determine definitely 
the duration of pregnancy. We cannot tell 
exactly the time of conception, and circum- 
stances influence the duration of pregnancy 
greatly. Thus, a woman who is perfectly 
tranquil in mind, sound in body, and amid 
peaceful surroundings, will go to the natural 
limit of gestation ; while another, harassed by 
care or over-taxed by pleasure, frail and ner- 
vous, will not go to the natural limit of preg- 



THE MOTHER. 21 

nancy, but will give birth to a child prematurely. 
The proportion between the size of the mother 
and that of the child has something to do with 
the duration of pregnancy. Nature usually 
brings about the birth of the child when fully 
developed, but when not too large to pass 
safely through the body of the mother. Ex- 
amination can usually determine with con- 
siderable accuracy the period of pregnancy. 
It is far better to rely upon the physician's 
examination than to make plans based ex- 
clusively upon the date of the last menstrua- 
tion. After the patient is seven months 
advanced, a skilful physician can usually re- 
cognize the period of gestation with accuracy. 

A Successful Pregnancy. 

A pregnancy is successful which results in 
the birth of a healthy living child, followed by 
the complete recovery of the mother. An 
unsuccessful pregnancy is one in which the 
child does not survive or is not sound in health, 
or in which the mother does not regain 
good health. In sound women, pregnancy 
under favorable conditions predisposes to good 
health. Even where patients are not them- 
selves perfectly sound, so much can be done 
by modern science to guard them against the 



22 MOTHER AND CHILD. 

dangers of pregnancy that healthy children 
may be born, and the mother's health pre- 
served in such cases. While pregnancy can- 
not be called a disease, it is a condition which 
requires observation and care from its earliest 
time. The circumstances of modern life are 
such that few women lead natural lives, and 
hence the modern woman is exposed to dan- 
gers during pregnancy which others might not 
have. These dangers can usually be over- 
come and pregnancy be successfully conducted 
to its natural termination. To accomplish this, 
the mother must consent to make her condi- 
tion of paramount importance. The demands 
of society, various enterprises, the care of other 
children, — everything, in short, but matters of 
life and death, — must be made secondary to 
the purpose of fulfilling the natural function. 
When we remember that upon the mother's 
condition and surroundings during pregnancy 
depend the life and health of her child, and 
especially its physical happiness in the future, 
this view does not seem unreasonable. If all 
patients were willing and able to subordinate 
the other factors in their lives to their care 
during pregnancy, there would be sounder, 
healthier, and happier children born into the 
world. 



THE MOTHER. 23 

The Dangers of Pregnancy. 

It would be false and wrong to unduly alarm 
pregnant patients. As we have said, preg- 
nancy is a natural function, and usually re- 
sults in improved health and strength to the 
patient. This, however, is true when she 
receives good care and when she is willing to 
avail herself of it. It is sufficient to intimate 
the principal dangers to which the pregnant 
patient is exposed by reason of her condi- 
tion. 

The danger that abortion will occur and that 
the product of conception will be lost before 
it can live outside the mother's body is present 
in all cases. While abortion is not a deadly 
danger to the mother, it is a very serious 
menace to her health, and often prevents sub- 
sequent pregnancy. It is most important that 
abortion should not occur if it can possibly be 
prevented. 

The conditions of the mother's life change 
during pregnancy. She virtually carries on 
two physical lives ; and so the problem of 
nutrition and waste becomes double in its im- 
portance. If proper care is taken at this 
time, the matter is readily adjusted with most 
patients. If attention is not given to the 



24 MOTHER AND CHILD. 

patient's food and to the disposal of the waste 
of the body, severe illness may result. 

These are the two great dangers to a suc- 
cessful pregnancy which exist in all cases. 
Each may be avoided successfully in nearly all 
patients by the exercise of good sense and 
reasonable care. Only a physician can ap- 
preciate the signs and symptoms of danger in 
these cases, and so the patient must expect 
to place herself under his guidance and with 
his aid to pass through a successful pregnancy. 

The Discomforts of Pregnancy. 

The discomforts of pregnancy may cause 
considerable suffering, although they may not 
be dangerous. Disturbances of digestion, 
altered sensations in the skin, inability to sleep 
naturally, weight and heaviness as pregnancy 
advances, and discomfort caused by the pres- 
sure of the growing child, may greatly annoy 
the patient. Fortunately, the physician can do 
much to lessen such discomfort, and modern 
methods of treatment have robbed pregnancy 
of many of its greatest annoyances. 



THE MOTHER. 25 

CHAPTER II. 

THE HYGIENE OF PREGNANCY. 

Food. 

By the hygiene of pregnancy we understand 
that general care of the health which greatly 
lessens the patient's discomfort, and often 
avoids dangerous complications. We can best 
understand what such care must be if we con- 
sider the needs of the patient in a healthful 
pregnancy. 

The patient is nourishing two lives, — her 
own and that of the child. It would seem 
natural that her appetite should be increased 
and that she should be able to take a greater 
amount of food than usual. In some healthy 
women this occurs. The patient is not sick 
in the morning, but takes more food and feels 
better during pregnancy than when she is not 
in that condition. In most patients, however, 
digestion is more or less disordered. It is 
evident that the quantity and the kind of food 
taken must be governed by the condition of 
the patient's digestion. If the patient cannot 
digest an ordinary mixed diet, her physician 
will advise the simplest foods, and trial will be 



26 MOTHER AND CHILD. 

made until that diet which best agrees is finally 
selected. Patients experience the greatest 
comfort when during pregnancy a successful 
diet is chosen. Physicians will supply to their 
patients diet-lists varying with the physical 
needs of each individual. In general, it may 
be said that those substances which are the 
most valuable foods are to be selected for use 
during pregnancy. Thus, milk, good bread, 
fruits, vegetables, and the most nourishing 
meats are selected. As pregnancy advances, 
the ability of the patient to digest meat often 
grows distinctly less. In many cases the quan- 
tity of meat must be reduced to a minimum, and 
with many patients it is omitted from the diet 
during the latter portion of pregnancy. Indigest- 
ible articles of food are never indicated during 
pregnancy. Those substances which are not 
foods, but which are drugs, are rarely needed 
in this condition. Such are alcohol, and tea 
and coffee in large quantities. In order that 
food may nourish, abundant water is necessary 
for the body, to provide fluids which act upon 
the food and to secure the dissolving of waste 
matter. While water is not a food, nutrition 
cannot proceed without it, and hence it is most 
valuable at this time when the patient is feed- 
ing two beings. 



THE MOTHER. 27 

Nausea and Vomiting. 

Morning sickness, or nausea, from which 
many persons suffer, can often be relieved by 
very simple means. It is better for the pa- 
tient to quickly and gently empty the stomach 
as soon as she rises in the morning, if she can 
do so. She will expel a small quantity of 
mucus and often a burning or acrid fluid. 
This is made easy if the patient will drink 
rapidly a full glass of water. This will be 
immediately rejected and with it the mucus 
and fluid. If the patient will then lie quietly, 
with her head low, she may be able to retain 
food after a few hours. If not, her physician 
will advise some method of treatment which 
will relieve her suffering. Vomiting during 
early pregnancy is a usual and not an unfavor- 
able symptom, and should not occasion con- 
cern. If the patient is nauseated during the 
greater part of the time, even though she may 
not vomit, she should consult her physician at 
once. 

Beverages. 

In early pregnancy, especially, much can be 
done for the patient's comfort by a judicious 
selection of beverages. Effervescing water, 



28 MOTHER AND CHILD. 

such as Apollinaris, Poland water, Vichy, and 
any pure aerated water, will often be found of 
great comfort. A pure water is desirable ; and 
if this is not readily obtainable, water may be 
boiled, and then exposed to the air and used 
as desired. Most patients are in the habit of 
drinking either tea or coffee when in good 
health. Neither of these is necessary during 
pregnancy ; but if the patient desires them, 
they should be used in small quantities only, 
freshly made and taken with food. Light cocoa 
agrees well with many ; buttermilk is very use- 
ful with some patients, and, in cases of neces- 
sity, other beverages may be prepared which 
prove most acceptable. Not only is alcohol 
not necessary in healthful pregnancy, but it is 
positively injurious to mother and to child. 
If there were no physical reason for abstaining 
from alcohol during pregnancy, the fear of ine- 
briety in the after life of the child should be 
sufficient warning. Pregnant patients should 
drink more than the usual amount of water. 
From one to two quarts in twenty-four hours 
should be taken. This may be between meals, 
on rising in the; morning, and before retiring. 
The temperature of the water may be agree- 
able to the patient, but extreme cold or heat 
should be avoided. 



THE MOTHER. 29 

Clothing. 

As pregnancy advances, the growth of the 
child obliges the patient to loosen her clothing. 
We occasionally see patients who do not ac- 
commodate the clothing to the growth of the 
child, and in whom the interruption of preg- 
nancy or injury to the child results. Most 
patients are much more comfortable if their 
clothing is arranged to accommodate the 
growing womb very early in pregnancy. 
There is one point of great importance in 
dress, and that is, that during pregnancy 
pressure upon the abdomen should be 
avoided. The patient may fulfil this in any 
manner best suited to her comfort and to her 
purse ; but the indication remains positive 
and the same with all patients. The suspen- 
sion of clothing from the shoulders and the 
substitution of a suitable waist for the corset 
is usually. successful in relieving the patient's 
discomfort and in preventing considerable 
danger of abortion. There are several sorts 
of waists available in the shops from which the 
patient may select. A well-fitting waist is 
comfortable about the bust, does not press 
upon the abdomen, is supported by the shoul- 
ders, and is so made that the underclothing 



30 MOTHER AND CHILD. 

may be buttoned to the waist, and not fastened 
about the abdomen. If the patient prefers, 
she can have made for herself a waist fulfilling 
these indications. The earlier the dress is ad- 
justed after pregnancy is recognized, the better 
for the patient in every way. Those who de- 
cline to accede to the needs of the situation 
are very apt to suffer greater inconvenience 
during pregnancy and confinement. 

Not only is the question of pressure im- 
portant as regards clothing, but also the tex- 
ture of the clothing next the skin. Here 
again each patient is a law to herself. If she 
is to continue in good health during preg- 
nancy, the blood must circulate freely through 
the skin. With some women this circulation 
is good when linen only is worn next the skin ; 
others can use silk ; others require woollen. 
The climate in which the patient lives has an 
important bearing upon the choice of clothing. 
Thus, a patient who goes from a hot city to 
the northern sea-coast must guard against the 
chilling of the body which follows a radical 
change of temperature. Woollen clothing is 
indicated in such a case. The patient living 
inland, where the air is warm and dry, is often 
better without woollen, or with underclothing 
containing but a small quantity of wool. Here 



THE MOTHER. 31 

also the physician's advice must be invoked, 
and it should be conscientiously followed. 

Patients feel a natural modesty in concealing 
the condition of pregnancy as long as possible. 
This can readily be done by a proper adjustment 
of the clothing. Those who imagine that the 
corset is valuable for this purpose are greatly 
mistaken. Alterations in the clothing which 
bring out the lines of the entire figure are 
more successful in this regard. The effort to 
compress the waist causes protrusion of the 
bust and of the lower part of the abdomen, 
which draws attention to the altered shape. 
Loosely-fitting clothing properly adjusted to 
the figure will often permit the patient to enjoy 
perfect comfort without attracting attention to 
her altered condition. 

No portion of the body should be tightly 
constricted by clothing during pregnancy. 
Circular garters should give place to those 
attached at the sides. Tight bands should be 
loosened, as swelling of the limbs and other 
parts of the body may follow their use. In 
the latter part of pregnancy the patient may 
require shoes larger than she is accustomed 
to wear. This requirement should be promptly 
met, as much discomfort is sometimes caused 
by the effort to wear the shoe usually employed. 



32 MOTHER AND CHILD. 

While it is possible to go through the entire 
pregnancy with but little alteration in clothing, 
still the best results for mother and child are 
not obtained in this way. The mother is far 
less comfortable and her general health far less 
good than if she adjusts her clothing to her 
altered condition. It is possible to seriously 
injure the unborn child by prolonged com- 
pression of the abdomen. A further reason 
for adjusting the clothing to suit the case lies 
in the fact that it is of the utmost importance 
that the patient's muscles should be free from 
restraint while she is pregnant. During labor 
these muscles are needed to assist in the birth 
of the child ; and if they are dwarfed by com- 
pression, the labor is longer and more painful. 
The figure of the patient will be regained more 
quickly after her recovery from labor and 
will be much better if she has not practised 
compression during pregnancy. She cannot 
prevent a permanent increase in the bones 
and in the general framework of the body, but 
this increase is symmetrical and not ungraceful. 
If nature be not interfered with, patients often 
develop physically during pregnancy and are 
much improved in appearance after their re- 
covery. 



THE MOTHER. 33 

Exercise. 

Some kinds of exercise are exceedingly 
beneficial during pregnancy, while others are 
most injurious. During early pregnancy the 
patient may feel too badly to undertake active 
exercise ; and should this be the case, she may 
yield to her feelings and keep as quiet as pos- 
sible. As pregnancy advances, however, she 
should be able to take exercise, and feel much 
better for so doing. 

Walking at a comfortable pace upon a 
level surface is the most beneficial exercise 
which a pregnant woman can take. Driving 
in a comfortable carriage over good roads is 
also useful in this condition. Injurious exer- 
tion is going up and down steep stairs, lifting 
considerable weights, reaching high above the 
head for some time, using a treadle, as in run- 
ning a sewing-machine, or any exercise which 
tends to jar or shock the body. Riding a 
horse or a bicycle is unsafe during pregnancy. 
Playing golf should be done with great caution 
only ; and swimming, to those accustomed to 
it and who have access to still water, may be 
indulged in with moderation. 

After pregnancy reaches the seventh or 
eighth month, exercise is a necessity. Walking 

3 



34 MOTHER AND CHILD. 

and going about the house performing the 
ordinary household duties should be freely 
carried out, as they serve a useful purpose 
in strengthening the mother's muscles and in 
bringing the child downward into the birth- 
canal. Confinement can be made somewhat 
easier and shorter if the patient takes exercise 
freely during the latter weeks of pregnancy. 

Exercise cannot be taken with comfort un- 
less the patient is suitably dressed and wears 
easy and comfortable shoes. She will be 
obliged to adjust her clothing if she is to take 
exercise in any form. 

Sleep. 

The patient needs an abundance of sleep 
during pregnancy. Occasionally cases are 
seen in which pregnancy seems to prevent 
sleep ; but when such is the case, the physi- 
cian must be consulted at once. Before preg- 
nancy is sufficiently advanced to have fcetal 
movements develop actively, the patient usu- 
ally rests without difficulty. As pregnancy 
advances, many patients require an increased 
supply of fresh air during the night. If this 
be supplied, sleep will often follow. With 
those who cannot sleep during the entire night, 
opportunity must be taken during the day to 



THE MOTHER. 35 

obtain sleep. If the patient's digestion is poor, 
it will often be much improved if she can sleep 
just before a meal. 

Baths and Bathing. 

It is of paramount importance that the pa- 
tient's skin be kept freely active during preg- 
nancy. In addition to cleanliness, baths fre- 
quently aid in relieving nervous irritability and 
in securing sleep. During pregnancy, baths 
should be neither hot nor cold. A cool sponge 
bath in the morning and a warm full bath in 
a tub at night are most useful during this 
time. The warm bath at night often aids in 
procuring sleep and adds greatly to the pa- 
tient's comfort. If the action of the skin is 
deficient, a sponge bath with cool salt-water in 
the morning is often useful. In cases where 
patients are annoyed by itching and burning, 
or by eruptions upon the skin, medicated baths 
are often prescribed by physicians. 

Constipation. 

Many patients suffer greatly from consti- 
pation during pregnancy. In some this is 
but an exaggeration of a usual condition. In 
others constipation becomes pronounced dur- 
ing pregnancy. 



36 MOTHER AND CHILD. 

This condition may be overcome, in almost 
all cases, by a well-selected diet and by the 
use of water. There is no drug which can 
be taken during the entire pregnancy without 
losing its effect and becoming in a measure 
injurious to the patient. A diet which con- 
tains an abundance of ripe fruit, stewed dried 
peaches, stewed apples, preserved pears, or 
stewed prunes, with oatmeal, cracked wheat, 
hominy, vegetables in season, and a consider- 
able quantity of fat in the shape of cream or 
butter, tends to avoid constipation. In addi- 
tion, water should be taken in abundance 
early in the morning. A diet which favors 
constipation contains tea and coffee in abun- 
dance, meat in great quantity, fried dishes, 
sweets, potatoes, peas, and beans, highly- 
spiced dishes, and but little water. 

Sometimes the most simple means will suffice 
to prevent constipation. A glass of cold water 
containing one-half teaspoonful of table-salt 
taken before breakfast aids many patients. A 
wineglassful of Hunyadi water, a teaspoonful 
of Rochelle salts in a glass of water, a tea- 
spoonful of Epsom salts, or of effervescing 
granular citrate of magnesia, is often sufficient. 
Drugs for constipation should be prescribed 
by the physician only, as each case demands 



THE MOTHER. 37 

especial study and no one drug is suitable 
for all. 

In addition to a proper diet and the use of 
simple remedies, exercise during the latter 
part of pregnancy is essential in avoiding con- 
stipation. Bathing greatly assists in this also. 

The Teeth. 

There is a distinct tendency to decay of the 
teeth during pregnancy. Toothache and neu- 
ralgia caused by decayed teeth sometimes oc- 
casion great suffering. The pregnant patient 
is not, however, able to bear prolonged dental 
operations or to suffer severe pain. During 
early pregnancy the patient's dentist should 
inspect her teeth, and he should be informed 
of her condition and govern his treatment 
accordingly. Dentists can supply temporary 
fillings and use remedies which stop toothache 
and decay until the pregnancy is over, when 
permanent fillings can be introduced. If the 
patient suffers from her teeth, the dentist 
should call upon her at her house and give her 
relief. No case of neuralgia in the face or 
head should be allowed to go on during preg- 
nancy without consultation with a dentist. In a 
large proportion of these cases, the cause lies in 
the mouth or teeth and can readily be removed. 



38 MOTHER AND CHILD. 

The Skin. 

Annoying and unsightly eruptions and dis- 
colorations of the skin are frequently present 
during pregnancy. A dirty brownish discolora- 
tion sometimes spreads over the forehead and 
face, greatly disfiguring the patient ; itching 
and burning sensations occur in various por- 
tions of the body ; sometimes blotches and 
pimples are greatly annoying. 

The brownish discoloration of the face, and 
sometimes of other parts of the body, cannot 
be removed in most cases before the termina- 
tion of pregnancy. It is not a permanent 
thing, and does not usually itch or burn. 
Many eruptions are remedied by the adoption 
of a suitable diet and the avoidance of consti- 
pation. Others require local treatment pre- 
scribed by the physician. In cases of obsti- 
nate burning and itching, the physician will 
examine the action of the kidneys and other 
excretory organs and study the patient thor- 
oughly to ascertain the cause. When this is 
found, the patient can usually be relieved. 
Eruptions and abnormal sensations in the skin 
are valuable indications of the general state 
of health, and should be reported to the phy- 
sician whenever they occur. 



THE MOTHER. 



39 



Nervous Disturbances. 

Pregnancy often causes distressing disturb- 
ances of the nervous system. Headache, 
neuralgia, itching and burning of the skin, 
perversions of appetite, profound mental de- 
pression, and occasionally perversions in the 
mind or affections of the patient may become 
very distressing. Great increase in the secre- 
tion of saliva and the formation of a large 
quantity of mucus in the mouth are also ob- 
served in some cases of pregnancy. It was 
formerly supposed that these conditions were 
inevitable ; but a better knowledge has taught 
us that there is in most cases a distinct cause 
for these conditions, and that this cause can 
readily be removed. The patient should re- 
port such symptoms promptly to her physi- 
cian ; or if she is not aware of them, her 
friends who notice them should report them. 
It is unnatural for a pregnant patient to be 
profoundly melancholy, depressed, and appre- 
hensive. She should not suffer from severe 
neuralgia, nor should she have an appetite for 
indigestible and extraordinary articles of food. 
She will not go on healthfully through preg- 
nancy if such conditions exist, and she cannot 
expect to have a healthy and sound child. 



4 o MOTHER AND CHILD. 

Accordingly, such symptoms must be reported 
promptly, and active treatment instituted, 
when 1 the patient will be cured or greatly re- 
lieved. 

Medical Advice During Pregnancy. 

In view of what has been said, it cannot 
seem unreasonable that patients need medical 
care during pregnancy. In many cases life 
can be saved, danger at confinement antici- 
pated and avoided, suffering prevented, and 
health maintained if the patient receives in- 
telligent care during pregnancy. Patients 
should report to a physician so soon as preg- 
nancy is suspected. If the condition be not 
present, but if the health be deranged, then 
treatment is needed to restore health. If 
pregnancy is present, care should be taken to 
avoid abortion and to keep the patient in good 
condition. It is often stated that child-bearing 
is a natural function and needs no interference 
and no supervision. This is only true in phy- 
siologically perfect individuals. Even among 
animals, who are supposed to be perfectly 
natural in their lives, complications arise 
during pregnancy and parturition, resulting in 
injury and in death. Among human beings, 
whose lives are constantly changed by their 



THE MOTHER. 41 

environment, physiologically perfect individuals 
are almost never seen. Advances in medical 
science, however, constantly increase the 
length of human life and lessen disease. The 
pregnant woman in common with other pa- 
tients should enjoy these benefits. 



CHAPTER III. 

THE UNBORN CHILD. 

Its Shape and Development. 

The unborn child is nourished at first by 
the absorption of nutritious matter contained 
within the sac which envelops the embryo. 
This sac has upon its outer surface shaggy 
projections, by which it adheres to the wall of 
the womb. Later on over an area of the sac 
these projections form the after-birth, or pla- 
centa, which remains attached to the wall of 
the womb. The umbilical cord develops, which 
passes from the placenta to the navel of the 
child, and through which blood passes. The 
child remains enclosed in a bag of membrane 
containing a fluid like water, which permits 
the child to move freely. Should the um- 



42 MOTHER AND CHILD. 

bilical cord become occluded by wrapping 
about the child or by pressure, the child would 
perish, like a diver whose air-tube might be- 
come cut off while he was working below the 
surface of the water. The oxygen of the 
mother's blood passes through the blood- 
vessels of the placenta to the blood contained 
in the umbilical cord, and in this way the child 
obtains oxygen and lives. Occluding the cord 
asphyxiates the child. The mother thus 
breathes for two and nourishes the child by 
the absorption of nutritious material from her 
blood into that of her offspring. The child 
does not breathe in the womb, because it 
obtains oxygen through the umbilical cord. 
When birth occurs, and the child is expelled 
into the world, and the cord is tied, breathing 
begins. 

The first movements of the child are usually 
felt about the fourth or fifth month. They 
are said to resemble the sensation given by a 
young bird held within the closed hand. In 
some cases the patient is frightened when 
movements are first felt. As the child grows, 
they become excessive, and so strong as to 
interfere with the patient's sleep. The more 
vigorous the child the stronger its movements 
will be. 






s° cr 




n 



c 




THE MOTHER. 



43 



A child is said to be viable when it can live 
outside the mothers body. The youngest 
child known to have survived was born twenty- 
six weeks after conception. It is not uncom- 
mon for seven months' children to live and to 
become as strong as those born at full term. 
There is no truth in the superstition that a 
seven months' child is more apt to live than one 
born at eight months. The older the child the 
better its chance for survival. (Figs, i and 2.) 

The child begins to assume human shape 
very early in pregnancy, and is fully formed 
by the fifth or sixth month. It increases 
in weight steadily until the termination of 
pregnancy ; male children usually weigh from 
seven to eight pounds, and female children 
from six and a half to seven and a half pounds. 
At birth a healthy child is twenty inches long, 
plump and well nourished, breaths easily, cries 
vigorously, and can grasp the mother's nipple 
and draw well upon the breast. 

The Determination of Sex. 

It is impossible to accurately determine 
before birth or to influence by any treatment 
during pregnancy the sex of the child. A 
shrewd guess may be made regarding sex by 
closely observing the beat of the fcetal heart ; 



44 MOTHER AND CHILD. 

but this is scarcely more than a guess, and 
cannot be relied upon for definite information. 

Transmitted Traits and Resemblances. 

The physical and mental traits of parents 
and ancestors are conveyed to children and 
descendants. It is a matter of common ob- 
servation that daughters often resemble the 
father and sons the mother.* Physical and 
mental traits may skip a generation, appearing 
in grandchildren. A physical peculiarity in 
the contour of the body may be transmitted 
through a long line. The tendency to pro- 
duce twins and triplets is also transmitted. 

Not only are physical traits and mental pecu- 
liarities transmitted, but diseases of the ner- 
vous system, and especially vicious habits, are 
conveyed from parents to children. This 
makes the responsibility of parents very great, 
and in some cases marriage should be avoided 
because of some tendency which may be 
transmitted. 

A Healthy Development of the Unborn Child. 

The question has long been asked, " What 
can be done to secure a healthful physical de- 
velopment in the unborn child ?" Observation 
and experiment have proved that in human 



THE MOTHER. 45 

beings and in animals, if the mother be sub- 
jected to physical and mental disturbance and 
interference, even though she be not severely- 
injured, deformity and imperfect development 
in her offspring will result. Among the poor 
who work in injurious places, in the fumes of 
chemicals, or in tobacco-factories, the blighting 
effects of these unfavorable conditions are 
seen upon their offspring. Lack of nourishing 
food and hard work make the children of the 
very poor puny and ill-nourished. Syphilis 
and drunkenness cause the birth of miserable 
beings, whose lives are a curse to themselves 
and to others. The avoidance of blows, falls, 
jars, strains, malnutrition, disease, and alco- 
holism is necessary to secure a good physical 
development of the child. The nutrition of 
the mother must be as perfect as possible. 

A Healthy Nervous System for the Child. 

While it is most desirable that the child 
should have a sound and healthy body, it is 
quite as important that it should be born with 
sound and healthy nerves and a normal brain. 
Here the physical is the basis of the mental. 
A child born of sound parents and well nour- 
ished before birth has an enormous advantage. 

There are certain conditions of the nervous 



46 MOTHER AND CHILD. 

system, however, which do not amount to 
positive disease, but which give distress to the 
individual during life. Those known as ner- 
vousness, excessive irritability, and unstabil- 
ity of the nervous system are not infrequently 
seen in children, and with many will persist 
throughout life. Such individuals are unduly 
sensitive, irritable, quick-tempered, hard to 
please, restless, unstable, and in adult life are 
often spoken of as "impossible persons." In 
many cases this is a direct inheritance from 
parents or grandparents ; in others it arises 
from the fact that during pregnancy the mother 
failed to have the quiet which is necessary for 
this condition. A long and tedious journey 
occupying several months of the period of 
pregnancy, free indulgence in society observ- 
ances, overtax in any occupation drawing 
heavily upon the nervous system, profound 
grief or emotion persisting during pregnancy, 
or a great sorrow coming upon the patient — 
any one of these may produce such a condi- 
tion in the unborn child. In proportion as the 
mother recognizes the situation, she can often 
by mental control obviate the danger. She 
can order her life so as to secure quiet and 
repose during her pregnancy. If sorrows 
come, she can bear them with the hope that 



THE MOTHER. 47 

the birth of the child will bring a new and in 
some way compensating happiness. While 
these conditions cannot always be avoided, they 
can in many cases be obviated or controlled. 

It was the belief of the Greeks that by 
surrounding herself with objects of beauty, 
by filling her mind with pleasing thoughts, by 
living in contact with nature in its most beau- 
tiful forms, the mother could influence the 
mind and body of her unborn child. This is 
more than imagination. The histoiy of the 
Greek race attests its truth, and modern ob- 
servation at the other extreme of the scale 
amid the poor comes to the same conclusion 
from the darker side of the picture. 



CHAPTER IV. 

HOW SHALL THE PRINCIPAL DANGERS OF PREG- 
NANCY BE AVOIDED? 

Abortion or Miscarriage. 

The term " abortion" is sometimes associ- 
ated with a criminal action where pregnancy 
is purposely interrupted. For this reason 
many do not speak of abortion, but of mis- 
carriage. 



48 MOTHER AND CHILD. 

The signs and symptoms of miscarriage are 
pain low in the back and low in the front of 
the abdomen, and a discharge of blood or 
bloody mucus from the vagina. The symp- 
toms are essentially those of returning men- 
struation. When these begin, the patient's 
physician should be promptly notified. 

To guard against abortion, or miscarriage, 
excessive fatigue, exposure to great heat or 
cold, violent exercise, great excitement, inju- 
ries, blows, falls, and accidents should if pos- 
sible be avoided. The patient's dress should 
be arranged in the manner suggested. When 
the first symptoms appear, the patient should 
immediately lie down and remain recumbent 
until she has been examined by her physician. 
Should hemorrhage be considerable, the nap- 
kins used should be saved for the physician's 
inspection. The patient's head should be low, 
and she should remain absolutely quiet. 

While the patient is naturally alarmed at 
symptoms of abortion, she may remember 
that bleeding is rarely dangerous in these 
cases, and that if she will keep perfectly quiet, 
the abortion may be checked. It is of the ut- 
most importance that the abortion be arrested, 
if possible, because damage to the patient's 
health may result if the process goes on. 



THE MOTHER. 



49 



The Toxaemia of Pregnancy. 

As the mother nourishes herself and the 
unborn child, she produces within her body an 
increased quantity of waste material. These 
substances are poisonous, and must be re- 
moved from the body if life and health are to 
continue. This is accomplished by the kidneys, 
the bowels, the liver, the skin, and the lungs. 
Hence the necessity that the patient should 
take plenty of water that the kidneys may act, 
that she should avoid constipation, that diges- 
tion be properly performed by the liver, that 
the skin be kept active, and that the patient 
have fresh air. When the waste of the body 
is not properly disposed of, a gradual poisoning 
results, which may go on to convulsions and 
to serious consequences for mother and child. 

The patient should report to her physician 
the presence of constipation, diminished action 
of the kidneys, biliousness and indigestion, 
swelling of the face or limbs, failure of the 
skin to act, headache, nausea, and disturbance 
in her vision. Fortunately, this condition 
usually develops slowly, and if the patient 
promptly summons medical aid she can be 
relieved. 

To assist the physician in preventing the 

4 



50 MOTHER AND CHILD. 

accumulation of these poisons, the patient must 
regulate her diet in accordance with his advice. 
Milk, fruit, and bread constitute an almost 
ideal diet for the pregnant condition. As 
each case demands individual study, the phy- 
sician will give each patient such directions as 
are needed. Patients sometimes imagine that 
they are being starved because they do not 
obtain meat and rich food. This is an un- 
fortunate mistake which has done much to 
favor the occurrence of disease. It is not 
what the patient eats, but what she digests 
and assimilates, which does her and the child 
good. She need not fear that the child will 
suffer because her diet is made a simple one. 
On the contrary, experiment has shown that 
the child is oftener better nourished and better 
developed when the mother's diet is restricted 
than when she indulges freely. Labor is often 
easier for the mother when she has followed a 
restricted diet, because the child is better 
adapted to pass through the bony portions of 
the birth-canal. 

The patient can aid the physician in pre- 
venting the toxaemia of pregnancy, not only 
by following his directions as to diet, but by 
sending regularly specimens of urine for ex- 
amination. That passed first in the morning is 



THE MOTHER. 51 

usually selected. At least four ounces should 
be sent as often as he may direct. He may 
also request that the quantity passed daily 
should be measured, and this may be a most 
important matter. By following his prescribed 
diet, by sending specimens for examination, 
and by reporting promptly any variation in the 
general health, the patient will aid greatly in 
this very important matter. 

Symptoms to be Invariably Reported to the 

Physician. 

For the safety of mother and child, the pa- 
tient should report at once symptoms of any 
derangement in her general health. She 
should be especially careful to report swelling 
of the extremities or of the face, dimness of 
vision, black specks or flashes of light seen 
before the eyes, headache above the eyes, and 
attacks of faintness. Should a discharge of 
blood occur resembling menstruation, this must 
be at once reported. Should pain in the lower 
part of the abdomen, followed by faintness, at- 
tack the patient, she should keep absolutely 
quiet and her physician be at once informed. 
It is better to report some unimportant symp- 
toms than to fail to detect a condition which 
requires attention. 



52 MOTHER AND CHILD. 

Rapid increase in the size of the abdomen 
is a symptom of importance as regards both 
mother and child. Very active and violent 
movements are indications which require in- 
vestigation. The cessation of the child's mo- 
tion should be at once reported. A notice- 
able projection in any part of the abdomen, 
with unusual movements of the child, requires 
attention. Where abnormalities arise con- 
cerning the child's position, it is usually possi- 
ble to rectify them if the physician be informed 
upon the first symptom. 



CHAPTER V. 

THE END OF PREGNANCY. 

We have already spoken of the methods 
usually employed to compute the duration of 
pregnancy. The physician's examination is 
far more reliable than any computation based 
upon the history of menstruation. As preg- 
nancy draws to its close, symptoms arise 
which usually give warning of approaching 
labor. If it be the patient's first pregnancy, 
the abdomen grows smaller. At its upper 



THE MOTHER. 53 

portion its circumference is much less, the 
patient breathes more easily, and grows 
smaller instead of larger. This is soon fol- 
lowed by a sensation of weight or heaviness 
low in the body, by frequent desires to empty 
the bladder, and often by irritation about the 
rectum. Slight backache and slight pain in the 
back frequently occur. Sometimes the patient 
is slightly nauseated, and in some cases pain 
is experienced along the inner side of the 

thighs. 

The Nurse. 

As early as possible the patient should have 
selected her nurse. This choice should not be 
made without consulting her physician, for 
doctors have better opportunities for learning 
the capabilities of nurses than have patients. 
On the other hand, the statement of a friend 
to whom a nurse has oriven satisfaction should 
not be ignored ; and if the nurse's profes- 
sional qualifications equal her agreeable quali- 
ties, so much the better. Obstetric nursing is 
a specialty, and cannot be successfully fol- 
lowed by the average nurse. An obstetric 
nurse cannot safely take cases of contagious 
disease. She requires especial experience 
and education ; and many hospitals which 
graduate nurses have no maternity wards and 



54 MOTHER AND CHILD. 

give no competent education in obstetrics. 
Hence, the fact that a woman is a trained 
nurse is no more evidence that she is qualified 
in obstetric nursing than is the fact that a 
physician holds a general diploma in medicine 
evidence that he is skilled in obstetrics or 
surgery. The obstetric nurse must be young 
enough to be strong and active, and have suf- 
ficient character to be self-possessed and 
thoroughly trustworthy. Above all, the ob- 
stetric nurse must have been thoroughly drilled 
in the practice of asepsis and antisepsis ; and 
failure in this cannot be made up by agreeable 
qualities, or age, or any other characteristic. 
As obstetric nursing requires especial skill, and 
is often very taxing to the nurse's strength, 
good prices must be paid for experienced ob- 
stetric nurses. 

The Room. 
When the patient accepts her nurse, it is 
the duty of the nurse to see that preparations 
are made for the approaching confinement. 
She will suggest the selection of a suitable 
room for the patient's confinement and re- 
covery. Such a room should be quiet, well 
ventilated, exposed to sunshine, and on the 
same floor with the bath-room. No plumbing 
should open in the room. If possible it should 



THE MOTHER. 55 

have an open fireplace and should be devoid 
of carpets and hangings. Clean rugs may be 
used. Frail and expensive furniture is not 
desirable, as sometimes medicines and anti- 
septic solutions may be spilled upon highly 
polished furniture and the polish ruined. Use- 
less furniture should be removed from the 
room, and a cot-bed should be available for 
the nurse's use immediately after the patient's 
confinement. A large screen should also be 

available. 

The Bed. 

A narrow, high bed, with a firm and com- 
fortable mattress, is most convenient for pa- 
tient and nurse. Nothing is more trying or 
increases the difficulty of properly caring for 
mother and child than a low, wide, heavy bed 
with elaborate furnishings. An abundant sup- 
ply of linen should be available, and such may 
be old linen which can be spared without much 
loss. Light blankets are desirable, and an 
abundant supply of small pillows. 

Medical Supplies. 

The physician will furnish his patient with a 
list of medical supplies which should be in 
readiness. Pharmacists often make it a point 
to fill out such lists and to procure all the 



$6 MOTHER AND CHILD. 

articles needed, sending them to the pa- 
tient in one package, which may not be 
opened until the supplies are needed. Each 
physician has his own list, including the arti- 
cles which he and his nurse consider necessary. 
Such supplies include antiseptics, stimulants, 
anaesthetics, surgical dressings, ergot, nail- 
brushes, catheter, medicine-dropper, and any 
other articles which the physician may person- 
ally desire. The surgical dressings purchased 
are usually furnished in sealed glass jars, and 
should not be opened until needed. Some of 
the antiseptics used are poisonous, and hence 
should not be left where children can get them 
or where servants ignorant of their properties 
might be tempted to use them. 

Dressings. 

An obstetric patient is practically a surgical 
patient, and her safety requires the observ- 
ance of the same principles of asepsis and 
antisepsis employed in modern surgery. She 
must have an abundance of aseptic or antiseptic 
dressings as ordered by her physician. These 
are obtained in one of two ways : If moderate 
expense is not an item, these dressings may 
be purchased in sealed glass jars from drug- 
gists or instrument-makers. The physician's 



THE MOTHER. 57 

list of supplies includes only sufficient of these 
prepared dressings for the confinement itself. 
Cheaper dressings, which are thoroughly effi- 
cient, may be made by a skilled obstetric nurse 
from inexpensive cheese-cloth and cotton. 
These must be sterilized by heat and soaked 
in antiseptic solutions in addition. The ob- 
stetric nurse may prepare these dressings at 
the patient's house before her confinement, 
putting them up in packages in sterile towels, 
and having them in readiness for use after 
confinement. The obstetric nurse should be 
compensated for the preparation of these 
dressings, unless the work is done when she 
is already in the patient's house in charge of 
the case. 

In addition to the absorptive dressings, 
bandages for the breasts and for the abdomen 
will be needed. These the nurse will prepare 
in accordance with the physician's directions. 
Rubber sheeting to fit the bed will be selected 
by the nurse, and an abundance of old sheets 
will be required in connection with the rubber 
sheeting. Clean basins and pitchers will be 
required, with an abundance of towels. These 
need not be of an expensive variety, so long 
as they have been repeatedly boiled and are 
thoroughly clean. 



58 MOTHER AND CHILD. 

Dangerous Articles. 

Articles which should never be used in an 
obstetric case are syringes which have been pre- 
viously used, old toilet sponges, napkins which 
have been worn during menstruation, bedding 
which has been used during a previous illness 
without disinfection, catheters and douche 
tubes which have been used. Blood-poisoning 
may follow the employment of any of these 
articles. 



CHAPTER VI. 

LABOR. 

By labor, or confinement, is meant the ex- 
pulsion of the child from the uterus. This 
process comprises three different steps or 
procedures. First, the womb must open suf- 
ficiently to permit the child to escape ; second, 
the child must be born ; and, last, the after- 
birth, the umbilical cord, and the membranes 
must be expelled. 

During the first portion of labor the patient 
may be annoyed by nagging pains in the lower 
portion of the abdomen, and apparently no 



THE MOTHER. 59 

progress may be made. The opening of the 
womb will go on, however, and finally the bag 
of membrane containing the water in which the 
child floats will protrude through the mouth 
of the womb and completely open the uterus. 
When this is accomplished, the membranes 
rupture, and some of the water escapes. Pa- 
tients are sometimes frightened by the sudden 
escape of a considerable quantity of water ; 
but when they are told why this happens, they 
have no cause for alarm. 

After the membranes rupture, the contrac- 
tions of the womb become stronger, and the 
child is gradually expelled. After the birth 
of the child, pains cease for about a half-hour, 
and then return in much diminished strength, 
when the after-birth is extruded. 

There is no definite limit to the length of 
labor or confinement, and many circumstances 
tend to vary its duration. A spontaneous 
labor is one in which the mother expels the 
child without special aid. When this is not 
possible, the child may be removed by some 
obstetric operation. 

Preparations for Labor. 

The nurse, if not already in the house, should 
be summoned as soon as labor pains begin. 



60 MOTHER AND CHILD. 

She will send for the physician when the proper 
time arrives. The nurse will require a plenti- 
ful supply of hot water. Whisky or brandy 
should be on hand, and the patient may 
need broth, soup, or some other liquid food. 
When the nurse arrives, she will properly 
dress the patient, prepare her bed, give an in- 
jection to move the bowels, and make suita- 
ble preparations for the labor. 

Essentials to the Conduct of Labor. 

Modern medical science surrounds the pa- 
tient during labor with the means for the pro- 
tection of her life and that of the child, and 
with agents to lessen suffering. Each patient 
in labor should enjoy the advantages of aseptic 
precautions, and, in addition, antiseptic treat- 
ment, if the physician deems it necessary. The 
poorest patients in hospitals are delivered 
under aseptic precautions, and even the poor 
in miserable hovels are attended by physicians 
who try to practise asepsis. In her own home 
the patient should certainly enjoy the benefits 
of asepsis and antisepsis during labor. 

It is usually possible at some time during 
labor to relieve the patient by an anaesthetic. 
The necessity for its use should be left en- 
tirely to the judgment of the physician. Im- 



THE MOTHER. 61 

properly employed, anaesthetics prolong labor 
and expose the patient to danger. Rightly 
used, they spare suffering and maintain 
strength. In some cases the condition of the 
patient may forbid their use, or it may be 
wise to avoid employing them in the interests 
of the child and the mother as well ; but such 
are the exception, and not the rule. There 
are certain drugs employed in modern ob- 
stetric practice to prevent hemorrhage. Ergot 
is most frequently used, and generally with 
success. Its taste is not extremely unpleas- 
ant, and the dose of the preparation usually 
given is one teaspoonful. Other remedies are 
chosen by the physician in accordance with 
each case. 



CHAPTER VII. 



OBSTETRIC OPERATIONS. 



Surgery in modern times has greatly re- 
lieved suffering and in many cases saved life. 
In other cases it prolongs life and preserves 
the patient's strength. Under aseptic pre- 
cautions, surgical operations are among the 



62 MOTHER AND CHILD. 

safest methods of treatment employed. So 
obstetric operations which remove the child 
from the mother's body, if done under aseptic 
precautions and with the same care which 
marks the modern surgical operation, save 
lives, relieve suffering, and maintain health. 
When a patient is told that it will be necessary 
to terminate her labor by operation, she should 
realize that this operation, if done in a clean 
manner, as modern surgery is done, will not 
only tend to preserve her life and that of her 
child, but also spare suffering and secure good 
health. Careful physicians obtain extra help 
for obstetric operations, just as surgeons have 
a physician to anaesthetize and nurses to assist. 
The same precautions regarding the steriliza- 
tion of instruments and dressings and clean- 
liness of hands are observed in obstetric 
operations which are successful in modern 
surgery. 

Operations which Remove the Child. 

When the mother fails to properly expel the 
child and it is best in her interest and that of 
the infant to remove it, some form of opera- 
tion is practised. An anaesthetic is given and 
the patient delivered. The child is often cared 
for before the mother wakes from the anaes- 



THE MOTHER. 63 

thetic, so that she may hear it cry and have it 
shown to her as soon as she is conscious. 

Operations for the Repair of Injuries. 

In cases where the mother fails to deliver 
herself, it is often because some lack of de- 
velopment is present which makes the birth 
of the child without injury to the mother im- 
possible. In many cases in which the mother 
expels the child herself laceration occurs. 
Obstetric operations do not cause laceration, 
but often prevent serious injury. In cases in 
which laceration occurs, unless some condition 
is present which makes repair unwise, it is the 
duty of the physician to repair the laceration. 
Patients must understand that laceration is 
often inevitable, but that under most conditions 
it can be almost immediately repaired. When 
a physician tells a patient that it is necessary 
to close a laceration, she must understand that 
she is receiving careful attention, and not that 
the physician is to be blamed because the 
laceration has occurred. In most cases lacera- 
tions are closed under anaesthesia. It is some- 
times necessary to omit the anaesthetic and 
to ask the patient to bear some pain for a few 
moments. When done in a throughly clean 
and careful manner, these operations prevent 



64 MOTHER AND CHILD. 

ill health, and spare the patient the necessity 
of undergoing an operation after she recovers 
from childbirth. 



CHAPTER VIII. 

THE PUERPERAL OR LYING-IN PERIOD. 

By this is understood the time occupied in 
the patient's recovery from confinement. As 
the mother is during most of the time in bed, 
it is often spoken of as the lying-in period. 
It has no definite duration, because it varies 
with the patient's strength and vigor and with 
her freedom from complications which may 
retard her recovery. From four to six weeks 
is the usual and normal duration of this period. 

Essentials for Good Recovery. 

For a patient to make a good recovery from 
childbirth, she must have sufficient rest. Im- 
mediately after labor, she needs absolute 
repose for a number of hours. The patient 
is naturally tired and exhausted ; and if she 
does well, her inclination is to sleep. This 
inclination should not be interfered with, but 



THE MOTHER. 65 

the patient should be allowed to sleep until 
she feels somewhat rested. She should not 
be disturbed for such a pretext as to see her 
family or friends or to receive congratulations 
over the birth of the child. This first rest is 
most important, as it prevents the patient from 
having complications which might become of 
a serious nature. After the first few hours the 
patient's rest should still be carefully guarded. 
The nursing of the child may be so arranged 
that the mother will have regular and undis- 
turbed rest and the child be trained into regular 
habits. So far as possible household cares, 
anxieties, and disturbances of all sorts should 
be kept from the patient ; and she should 
have mental as well as physical rest. 

Strict cleanliness, both general and surgical, 
is essential for the good recovery of the patient. 
The lochial discharge coming from the birth- 
canal should be absorbed by antiseptic dress- 
ings, and these should be changed sufficiently 
often to keep the patient clean. At each 
changing the nurse, under antiseptic precau- 
tions, will cleanse the patient thoroughly as 
the doctor may direct. Vaginal douches 
should be given by the doctor's order only 
during the puerperal period. The insertion 
of a douche tube may be followed by serious 

5 



66 MOTHER AND CHILD. 

results, unless every antiseptic precaution be 
taken. The nurse will cleanse her hands 
carefully before attending to the patient, and 
will see that soiled dressings are burned as 
soon as possible after they are removed. 
Clean and antiseptic dressings should be used 
to protect the nipples from contact with cloth- 
ing,, and thus prevent injury and infection. 
The lying-in patient requires clean and surgical 
dressings over the breasts and about the lower 
portion of the body. These are retained in 
place by bandages, which, if properly applied, 
do not increase the patient's discomfort. Pa- 
tients should co-operate with the nurse in 
every way in maintaining cleanliness, and thus 
by tact and good management she can secure 
the burning of soiled dressings without seri- 
ously interfering with the servants of the 
household. 

Proper nourishment is also essential in se- 
curing a good recovery from labor. For her 
own sake, as well as for the child's, the mother 
must be contented with simple and easily-di- 
gested food. While lying in bed she will not 
assimilate heavy foods, such as meat and rich 
and made dishes. Her child will not be well 
nourished if she takes such articles. Her food 
must be limited to the most easily-digested and 



THE MOTHER. 67 

nutritious articles, and these will be ordered 
by her physician. Among the foods especially 
employed with success during the puerperal 
period are milk, with cracker, or with lime- 
water, or diluted with Vichy or Apollinaris or 
soda-water, or made into junket, milk-pud- 
dings, custards, or peptonized. Chicken, 
mutton, veal, and clam broths, purees, gruels, 
cocoa, milk-toast, light puddings, blanc-mange, 
and charlotte russe are also given. Stewed 
fresh peaches, or stewed fresh apples, baked 
apples, stewed dried fruits, preserved pears, 
and stewed prunes are often used. When the 
patient is some days advanced in recovery, 
she may be given once daily a small quantity 
of easily-digested meat, such as chicken, lamb, 
sweetbread, or a soft egg. In season, oysters 
are often very acceptable. When vegetables 
are added to the diet, fine spinach and rice are 
usually the first given. If the patient has been 
so accustomed to tea and coffee that she cannot 
do without them, they may be used in small 
quantities only, but a lying-in patient does not 
need them. Alcohol is almost never required 
in this condition. It is very essential that the 
patient take an abundance of water, and this 
may be any form of pure water which she 
prefers. Food should be taken at regular 



68 MOTHER AND CHILD. 

intervals, and a sufficiently varied diet should 
be given to maintain appetite. If possible, 
the patient should not be told what she is to 
take, but the food should be prepared and 
brought to her in the most appetizing manner 
possible. 

Nutrition cannot go on properly without 
especial attention to the movements of the 
bowels. Within a short time after labor the 
patient's bowels must be very thoroughly 
moved. After that, daily movements must 
occur ; the physician will prescribe simple 
medicines, and enemata will often be given in 
addition. If the nurse is skilful and careful 
in giving such injections, they will not cause 
great discomfort to the patient. Many pa- 
tients suffer great annoyance because they 
cannot empty the bladder and rectum while 
lying down. A little patience will usually 
overcome this difficulty ; and if recovery goes 
on well, the physician will allow his patient to 
use a commode as soon as possible. 

Lactation. 

Milk is usually present in the breasts during 
the latter weeks of pregnancy. During preg- 
nancy the breasts and nipples should be in- 
spected, and if the nipples are depressed or 



THE MOTHER. 69 

sunken, they should be drawn out by the 
thumb and finger. The nipples should be 
thoroughly but gently cleansed with castile 
soap and warm water once daily ; and if there 
is a disposition to cracks or fissures of the 
nipple, the physician will give the patient a 
suitable application for this purpose. Patients 
should not use miscellaneous prescriptions 
which their friends or which nurses are apt to 
advise. Patients should avoid the use of alco- 
holic preparations and astringents, as these 
make the nipple more liable to crack and 
injury. The formation of milk begins in the 
breasts on the second or third day after the 
delivery of the child. Sometimes the breasts 
fill very suddenly, and, becoming greatly 
swollen, cause much suffering. In other cases 
they become distended so gradually as to 
cause little distress. If the breasts are greatly 
distended, the patient may feel sore in the 
arm pits, and occasionally the sides of the 
neck and face swell in addition. When the 
milk begins to run freely from the breasts and 
the child to nurse, the secretion greatly lessens 
in quantity until sufficient milk, but no more, 
is formed for the use of the child. 



70 MOTHER AND CHILD. 

When and How Shall the Child Nurse? 

The child shall nurse for the first time after 
the mother has had a good sleep and wakes 
refreshed. It is sometimes necessary to put 
the child to the breast at once. During the 
first twenty-four hours the child usually nurses 
every four hours, during the second twenty- 
four hours every three hours, and after that 
every two and a half to three hours. Occa- 
sionally the child nurses every two hours 
during the greater part of the time. Nursing 
should be entirely suspended for from six to 
eight hours at night. The mother needs this 
rest and the child requires uninterrupted sleep. 
It is usual to have the child nurse at regular 
intervals from six or seven in the morning 
until ten or eleven at night. After the last 
nursing, it should not be nursed more than 
twice in exceptional cases, usually but once, 
and as soon as possible the child should not 
nurse for six or eight hours. The constant 
tendency is to have children nurse too often, 
thus disturbing the mother and overburden- 
ing the child's stomach. If strict regularity in 
the child's nursing be observed, it will form 
regular habits, which have much to do with 
good nutrition. The danger is that the mother 



THE MOTHER. 71 

will think the child is hungry whenever it 

frets or cries. The child will usually take the 

breast as often as it is offered. Too frequent 

nursing gives the child indigestion and makes 

it very fretful, and so a disturbing cause is 

constantly present. For the child to properly 

nurse, it must be supported in an easy posture 

upon the mother's arm and the breast so 

turned that the nipple will fall readily into the 

child's mouth. From fifteen to twenty minutes 

is necessary, and the effort should be made to 

keep the child awake during this time when 

nursing. If the milk comes so fast as to 

embarrass the child, the mother may compress 

the nipple gently between two fingers and 

thus hinder somewhat the flow of milk. The 

child should not be allowed to keep the nipple 

in its mouth when it is not nursing, nor should 

it be allowed to lie asleep with the nipple in 

its mouth. 

Care of the Breasts. 

Unless the breasts are properly cared for 
the nipples may become cracked and sore, the 
breasts caked, and much suffering result. To 
keep the nipples sound, the nurse will thor- 
oughly cleanse them before and after the child 
nurses, and apply antiseptic solutions which 
will not irritate, but which will prevent the 



72 MOTHER AND CHILD. 

growth of bacteria. The use of antiseptic 
dressings upon the nipples does much to pre- 
vent cracking and inflammation. The nipples 
should not be touched by hands that have not 
been made thoroughly and surgically clean, 
and should be protected from contact with 
the patient's clothing. In order to preserve 
the nipples in a sound condition, they are 
covered by sterile or antiseptic dressings, and 
the breasts are supported and the dressings 
kept in place by the application of suitable 
bandages. These may be modelled after a 
waist having supporting pieces over the shoul- 
ders attached to the edges of the bandage, 
which is pinned about the chest. Others pre- 
fer a loop or figure-of-eight bandage going 
underneath the breast and over the opposite 
shoulder. It is not essential what form of 
dressing is applied, so long as the indications 
are fairly met. 

Caked Breasts. 

By the term " caked breasts" is described a 
condition in which the breasts become over- 
distended with milk and are hard and painful. 
This condition requires prompt attention, and, 
if taken in hand at once, can in almost all 
cases be relieved without delay. It arises 



THE MOTHER. 73 

from the very rapid and free secretion of milk 
which accumulates in the breasts consoli- 
dating or stretching the ducts in which it is 
contained. If the milk can flow out freely, 
the distention is gradually lessened. 

This condition is one which requires intelli- 
gent and skilful treatment, and is one in which 
much harm may be done if the patient does 
not receive proper treatment. As the breasts 
are sensitive and delicate organs, bruising or 
roughness in their treatment will not only 
cause suffering, but is almost inevitably fol- 
lowed by serious consequences. Hence the 
treatment must be conducted in a skilful man- 
ner. The doctor will order what he wishes 
done in these cases, and the nurse under- 
standing his directions will relieve the patient 
as speedily as possible. If the distension be 
extreme, the patient cannot escape suffering, 
and often the first efforts made to secure a 
free flow of milk will cause pain ; but if she 
will have patience for a short time, she will be 
permanently relieved. 

Methods of treatment employed in these 
cases consist in the application of heat and 
occasionally of cold. Heat is applied in the 
form of flannel wrung out of hot water, and 
sometimes sprinkled with turpentine, alcohol, 



74 MOTHER AND CHILD. 

or camphor, and placed upon the breasts. 
Over this is spread oiled silk or dry flannel. 
The breasts are also massaged to relieve over- 
distention. This requires skill and experience, 
and, if badly done, will cause great pain and 
injure the breast. The hands of the masseuse 
must be surgically clean and thoroughly warm. 
Sterile olive oil is usually employed. Hav- 
ing annointed her hands with this, the mas- 
seuse raises the breast gently, and beginning 
at the outer border, rubs towards the nipple. 
A skilful nurse will detect those parts of the 
breast where distention is greatest, and will 
do much to relieve the patient by this manipu- 
lation. No one but a skilful and experienced 
nurse can do this successfully. The applica- 
tion of the breast-pump to withdraw milk is a 
method of treatment also employed. The 
breast-pump comprises a glass bell, which is 
placed over the nipple and connected with a 
rubber bulb. By compressing the bulb before 
applying the breast-pump, a vacuum is created, 
and atmospheric pressure forces the milk out 
at the nipple. The breast-pump must be used 
with skill and judgment, as its careless and 
improper employment may cause pain and do 
damage. The nursing of the child is the 
natural relief for an overdistended breast. 



THE MOTHER. 75 

When the tension is so great that the child 
cannot start the milk, the nurse will lessen 
the tension by some method of treatment, and 
then apply the child to the breast. So soon 
as the child begins to nurse, the tension will 
be relieved. When the child is old enough to 
nurse regularly and freely, it will relieve the 
tension in this way. A skilful nurse, with the 
co-operation of her patient, will usually pre- 
vent serious complications on the part of the 
breasts. The patient, however, must aid in 
every way, as without her co-operation nothing 
can be accomplished. 

Sore Nipples. 

Sore nipples usually arise from cracks or 
fissures caused by the bruising of the nipple, by 
the biting of the child, or by some injury to the 
nipple while bathing or rubbing. Such cracks 
and fissures become very sore when the child 
nurses, and if infection enters, inflammation 
of the breasts and abscess may result. A 
crack or fissure in the nipple is an annoying 
complication which requires good care and 
close attention. 

In most cases fissure is prevented by the 
examination of the nipples during pregnancy, 
and by the application of healing remedies to 



76 MOTHER AND CHILD. 

prevent cracking. When fissure does occur, 
a nipple-shield is usually employed to protect 
the nipple from the child's mouth. This con- 
sists of a hollow glass cone or bell placed over 
the nipple, to which is attached a rubber nipple 
for the child to grasp. This usually gives 
great comfort to the mother, and in most cases 
can be successfully used by the child. When 
fissures of the nipple occur, the physician will 
prescribe applications of medicine to heal 
them. The nurse will make these under 
strict antiseptic precautions. Cleanliness and 
strict antisepsis are far more important in 
these cases than the application of medicine. 
If the nurse is not clean, or if the mother 
interferes with the dressings and bandages, 
infection may occur through the crack or 

fissure. 

Inflammation of the Breasts. 

Germs are sometimes present in the ducts 
of the breast before the child is born. When 
the breasts are engorged by milk, these germs 
invade the tissues and set up inflammation. 
Germs usually enter the breasts through the 
nipples, and sometimes through cracks or 
fissures. They cause inflammation, and in 
some cases this goes on to the formation of 
pus or abscess of the breast. Under strict 



THE MOTHER. 77 

cleanliness and good care in the prevention 
of engorgement, inflammation of the breast is 
rare. It may, however, happen in spite of all 
known precautions. When pus is formed and 
a definite abscess is present, the abscess must 
be opened, the pus allowed to discharge, and 
the abscess cavity cleaned. 



CHAPTER IX. 

COMPLETE RECOVERY FROM CHILDBIRTH. 

For a patient to make a complete recovery 
from labor she must have escaped septic in- 
fection or have recovered from such infec- 
tion. Lacerations of the birth-canal must 
have healed either with or without the applica- 
tion of stitches. The patient must be thor- 
oughly and well nourished, and is usually in 
better condition than before the birth of the 
child. She must have had sufficient rest for 
the nervous system to be in a perfectly 
well-controlled condition. The womb and 
birth-canal must have contracted to nearly its 
normal shape and size, a process known as 
involution. This is only possible when the 
other factors in the problem have been satis- 



78 MOTHER AND CHILD. 

factorily solved. While physically the pa- 
tient's stature and shape can never be exactly 
the same as before childbirth, still she should 
recover free from disease of the womb and its 
appendages and be in good general condition. 

Sitting Up. 

By assuming various postures while in bed 
the patient should aid somewhat in her recov- 
ery. She should not lie upon the back all of 
the time, but should turn upon the sides ; and, 
if she desires, may turn upon the abdomen. 
She should be slowly propped up in bed as 
the doctor orders ; and when the womb is 
sufficiently contracted and her general con- 
dition is good, she should gradually be allowed 
to sit up, and finally to get out of bed. The 
belief that patients should sit up on the tenth 
day has no basis of fact. One patient may 
be able to sit up on the tenth day and an- 
other on the twentieth, and each case must be 
decided on its own merits by the physician in 
attendance. He will examine the patient from 
time to time and thus determine when she can 

sit up. 

Getting Back the Figure. 

Patients are often anxious to know regard- 
ing the getting back of the figure. To under- 



THE MOTHER. 79 

stand this we must know what is meant by 
the term " figure." Many women who have 
worn corsets for some time mean by the term 
"figure" the same degree of compression 
which they are accustomed to make by the 
corset. We have never met a patient who 
acknowledged that she had worn a corset 
tightly, so that in our experience alterations 
in the shape cannot come from wearing tight 
corsets, but simply from the corset itself. 
When the patient asks about getting back 
the figure, she usually means when can she 
wear the same corset, laced in the same way, 
as she did before the child was born. So far 
as the patient's actual size is concerned, the 
skeleton and all parts of the body increase 
during pregnancy. The patient is never ac- 
tually as small after pregnancy as before ; and 
if this is a matter of vital importance, then 
the pregnancy has been a calamity. In the 
normal human figure certain proportions are 
present between the head and the circumfer- 
ence of various parts of the body. If by the 
term " figure" these proportions are meant, a 
patient can get back her figure who makes a 
good recovery from childbirth, who has the 
weak muscles brought up by massage, who 
does not get up too soon, who nurses the 



80 MOTHER AND CHILD. 

child, if possible, and who is careful about 
exaggerating the figure by compressing one 
part of the body at the expense of another 
portion. The getting back of the corset figure 
is largely a matter of endurance, as patients 
vary in their ability to stand pressure and in 
their willingness to do so. 

The patient's going down-stairs is permitted 
by her physician when her general condition 
justifies it. Going up-stairs is more inju- 
rious to the patient than going down. It 
may be necessary to carry her up-stairs for 
a few days, or to have some person stand di- 
rectly behind her, and, putting the hands upon 
her hips, raise her body while she makes the 
upward step. She should not strain or pull 
in going up-stairs. A patient may go out so 
soon as her general condition permits and the 
weather is suitable. Usually a drive is first 
allowed, and then a short walk upon the level. 
Good air and bright sunshine should be 
chosen for the first outing, if the weather be 
cool. In hot weather the early evening is 
usually the best time. 



THE MOTHER. 81 



CHAPTER X. 

HOW LONG SHALL THE MOTHER NURSE THE 
CHILD ? SUCCESSFUL NURSING. 

Diet. 

When the mother nurses the child suc- 
cessfully, it gains in weight from one-half to 
one pound each week, its digestion is good, 
it is satisfied with its food, and sleeps and 
rests normally. The mother is also in good 
health, her appetite, her digestion, and her 
strength remaining good also. 

To secure this result the mother's diet must 
be regulated in accordance with the end in 
view. Milk prepared in any acceptable way, 
an abundance of good bread and butter, fresh 
vegetables in season and thoroughly cooked, 
ripe fruits in season, — raw, stewed, or baked, 
— eggs simply cooked, a moderate quantity 
of digestible meat, fish in season, oysters, 
and simple desserts should compose the diet. 
Water, milk, and cocoa are the best beverages. 
Tea has a great reputation among the poor 
for stimulating the flow of milk, but this rests 
upon no accurate testimony, and those nursing 



82 MOTHER AND CHILD. 

women who drink large quantities of tea are 
usually in poor condition and their children 
are not well nourished. Some think that 
coffee lessens the flow of milk ; but of this we 
have not sufficient proof. That cocoa and 
milk favor the formation of breast-milk there 
can be no doubt. 

Some form of alcoholic beverage is fre- 
quently recommended by friends to women 
who are nursing children. Beer, ale, and 
porter are supposed to be especially valuable 
for this purpose. Our experience does not 
bear out this recommendation, as in many 
cases the attempt to use beer, ale, or porter is 
followed by impairment in the patient's di- 
gestion, by biliousness, and by derangement 
of the child's digestion as well. Malt liquors 
may well be substituted by an extract of malt. 
The best malt extracts contain but little sugar 
and are prepared especially to avoid over- 
taxing the patient's digestion. A nursing 
mother should avoid the use of alcohol if pos- 
sible, because of its influence upon her diges- 
tion and its possible influence upon the child. 

The cardinal point in selecting diet during 
nursing is that the mother avoid food which 
overtaxes her powers of digestion. Food 
commonly classed as rich* and indigestible 



THE MOTHER. 83 

should be excluded. An abundance of the 
best food, that which is most nutritious and 
digestible, is required. 

Exercise. 

Where a mother is usually robust and has a 

strong digestion, her milk may not agree with 

the child because it is too rich. In such a 

case the mother should take exercise in the 

open air, and by so doing she will lessen the 

quantity of the richer portions of the milk and 

make it "more easily digested by the child. 

Any form of exercise which agrees with the 

patient may be chosen. She must avoid 

mechanical injury to the breasts and also 

taking a severe cold. In hot weather, if she 

is accustomed to sea-bathing and avoids injury 

by the waves, she may go into the water with 

great benefit. 

Constipation. 

If a nursing mother becomes obstinately 
constipated, her digestion will become dis- 
ordered and her milk will not agree with the 
child. In selecting laxatives, some are es- 
pecially disposed to cause irritation and to 
give the child discomfort. The simplest laxa- 
tives should be used, unless the patient's phy- 
sician orders otherwise. Such laxatives as 



84 MOTHER AND CHILD. 

castor oil, cascara, citrate of magnesia, and 
syrup of figs may usually be employed without 
disturbing the child. Ripe fruits in season or 
stewed fruits are the best laxatives, and fruit, 
if cooked, will rarely cause irritation in the 
milk or disturb the infant. 

The Child's Weight. 

The most reliable index of the growth and 
general prosperity of the child is its weight. 
Suitable scales should be at hand when the 
child is born, and it should be weighed at 
regular intervals. Once weekly is usually 
sufficient to weigh a child, although in some 
cases the child is weighed every two or three 
days. A healthy nursing infant should gain 
from a half ounce to an ounce each day. In 
some cases a healthy nursing infant has gained 
a pound and a half each week for several 
weeks after birth. The child will lose weight 
in many cases for the first five or six days 
after birth. This loss is occasioned by vari- 
ous causes ; but as soon as the mother be- 
gins to furnish the infant fully-formed milk, 
the child should gain and continue so to do. 
The child's weight is a valuable index of the 
mother's success in nursing it and should 
never be disregarded. 



THE MOTHER. 85 

Influence of Nursing Upon the Mother's 
Health. 

When the mother can successfully nurse the 
child, it is far better for her so to do. She 
makes a better recovery from childbirth and 
usually a more rapid recovery. While nursing, 
conception rarely occurs, and this protects the 
mother from the strain of rapidly succeeding 
pregnancy. Some patients gain in weight 
while nursing and others lose. Those who 
lose often have the more abundant supply of 
milk. Neither gain nor loss in the mother's 
weight is of especial importance, provided she 
remains well during the time. Laying aside 
the interests of the child, in the mother's in- 
terest only it is far better that she should 
nurse her infant if possible. Many patients 
who cannot nurse a child completely can par- 
tially nurse it, and this is much better than 
abandoning nursing entirely. The child may 
be fed during the day in these cases and the 
mother nurse it at night and in the early 
morning. In this way the infant gets the 
most digestible food the last thing at night 
and the first in the morning, and this avoids 
indigestion during the night, which disturbs its 
sleep and that of the parents. The mother 



86 MOTHER AND CHILD. 

has the day free from the care of nursing, 
while the continuance of lactation protects her 
from pregnancy and helps in securing a good 
recovery from childbirth. Modern methods 
of infant feeding are at present so successful 
that it is rare to find a case which cannot be 
assisted during lactation without disturbing 
the health of mother and child. 



PART II.— THE CHILD, 



CHAPTER I. 

THE CRADLE. 



Modern ideas regarding sanitation and con- 
venience have gone so far as to take notice 
of the baby's cradle. The old mahogany 
cradle on rockers, but a few inches above the 
floor, which sheltered generations of a family, 
is now looked upon as a curiosity. The mod- 
ern mother does not sit with the cradle at her 
feet and by placing her foot upon it rock her 
child to sleep. Rocking the cradle is practised 
less among those who are anxious to do for 
infants what modern knowledge deems wise. 
The objection to the low wooden cradle upon 
rockers is that it placed the child too near the 
floor, where it was exposed to draughts. The 
rocking motion is thought by some injurious, 
as it tends to disturb the child rather than to 
lull it to sleep. The low wooden cradle could 
not be moved from place to place. In its stead 

87 



88 MOTHER AND CHILD. 

the bassinette has come into extensive use. 
Made of wicker, the bassinette stands higher 
than the ordinary bed, is readily moved, and 
is not upon rockers. Its structure permits 
the mother to fit to it simple hangings, which 
add to its beauty and make it comfortable for 
the child. (Fig. 3.) Many bassinettes are made 
in two parts, — basket and frame. The basket 
may be readily lifted out of its frame and car- 
ried with its contents wherever desired. The 
bassinette is undoubtedly the most convenient 
and suitable nest for the infant which has yet 
been devised. The simplest and cheapest bas- 
sinette is a clothes-basket. Several blankets 
may be put into the basket, its sides protected 
by a light blanket or sheet, and the child then 
placed in it. The basket should stand upon a 
low table or upon two chairs. It is not uncom- 
mon to see this use of a clothes-basket by 
persons of limited means, and in this way it 
answers every indication. 

The Crib. 

The modern crib, like the modern bed, is 
of iron or brass, enamelled or polished, and 
fitted with mattress, bedding, and pillows. 
These cribs generally have sides which let 
down, and are upon casters. They are sufri- 



Fig. 3. 




Bassinette. 



THE CHILD. 89 

ciently large to accommodate a child several 
years old. A railing high enough to prevent 
a child of eighteen months or two years from 
falling out is attached. This railing, with its 
divisions, is sometimes a source of danger. 
Cases have been observed where active chil- 
dren made their way between the spokes or 
bars of the railing, and, being caught in very 
unfavorable positions, were severely injured. 
The crib is not very easily moved, but it is 
convenient, because it serves as the child's 
bed for a number of years. Being of metal, 
it can be thoroughly cleaned and disinfected. 
Many cribs have canopies, fitted with cur- 
tains or mosquito-netting. Hangings may be 
fitted to a crib in any way to suit the taste 
of the mother. The mattress of the crib 
should be of the very best quality of hair and 
its pillows carefully chosen. Its bedding may 
vary in texture with the means and taste of 
the mother. 

Other Receptacles for an Infant. 

Improvised receptacles for the infant are 
sometimes amusing, and occasionally pathetic. 
Among the poor, the baby is not infrequently 
put into a wash-tub, in which has been placed 
an old quilt or a blanket. The baby-carriage 



go MOTHER AND CHILD. 

of the poor mother often serves night and 
day as a receptacle for the child. 

Shall the Child Remain with the Mother? 

In the interest of both mother and child it 
is best that the child should not be with the 
mother continuously. One will disturb the 
other, and neither will obtain necessary rest 
if they remain together. During the lying-in 
period it is best to have the child's resting- 
place in a room adjoining the mother's, where 
the nurse can attend to the child without waking 
or disturbing the mother. Where a separate 
room is not available, the child's crib may be 
surrounded by a large screen, thus practically 
making a small room for it. If the child must 
be kept with the mother, and there is no intel- 
ligent care-taker for the child, the mother may 
put the crib beside her bed, so that she can 
reach the child if necessary, while the child 
has a separate covering and resting-place. 
Children lying in bed with the mother have 
been severely injured through accident by the 
mother while asleep ; so that it is never wise 
for the mother and child to sleep together. 



THE CHILD. 91 



CHAPTER II. 

THE CHILD'S CLOTHING. 

From the traditional rabbit skin to the elabor- 
ate wardrobe for infant royalty, infants' clothing 
has always excited a lively interest. Fashion 
has influenced such garments. The desire for 
luxury and display has been shown in this 
respect as in the clothing of elders, and com- 
fort in the sense of fitness is displayed in this 
particular of the infant's care as well as in 
greater matters. The ideal infant's clothing 
is the rabbit skin. The material, soft, warm, 
fitting the body perfectly, permitting free mo- 
tion, and constantly renewed by growth, makes 
the best clothing. Centuries of civilization 
have so changed the skin of the infant that 
artificial protection has become a necessity. 

The dress of the new-born child is modified 
in some particulars by the necessity for a dress- 
ing upon the umbilicus and the wearing of the 
diaper. (Fig. 4.) Its clothing should be more 
simple than that of the older, child. Neces- 
sary garments should be so adjusted that they 
may be changed with the least disturbance to 



92 MOTHER AND CHILD. 

the child and should fit the child in such a 
manner as to permit unrestrained motion. 
The dressing upon the umbilicus is kept in 
place by a flannel bandage, which should ex- 
tend over the entire abdomen. After the 
dressing of the umbilicus is discarded, a knitted 
band should be worn. The diaper of the child 
covers the bottom of its body, extends one- 
third of the way upon its thighs, and is pinned 
in front to the flannel bandage or knitted band. 
(Figs. 5 and 6.) The feet are covered by 
knitted socks of either wool or wool and silk. 
At night a high-necked and long-sleeved flan- 
nel night-gown is worn (Fig. 7); and in the day- 
time for the first few weeks a similar gown may 
be worn, covered with a simple white muslin 
slip ; but the gown should be changed at night, 
if circumstances permit, so that one should not 
be worn through the twenty-four hours. For 
the daytime the new-born infant requires a 
light woollen shirt, with sleeves reaching to its 
wrists. Over this a slip of light woollen ma- 
terial, fastened on the shoulders and without 
sleeves, should be worn. (Figs. 8 and 9.) A 
white slip, also fastening on the shoulders, 
without sleeves-, may be worn under the dress. 
The flannel and cotton slips should be put on to- 
gether. (Fig. 10.) The dress should be put on 



Fig. 7. 




Convenient night-clothes with feet. Suitable for child after earliest infancy. 



Fig. 8. 




Long flannel skirt, fastened by buttons on shoulders. No sleeves. Worn with 
high-necked and long-sleeved undershirt. 



Fig. 9. 




White muslin petticoat, coming from shoulders. Worn over flannel slip. Only 
necessary under fine muslin dresses. Makes too many garments on very young 
baby. 



Fig. io. 




Another view of petticoat shown in Fig-. 9. 



Fig. ii. 




Child fully dressed with simple white nainsook dress, trimmed with lace edging; 
very simply but beautifully made. 



Fig. 12. 




View of long white nainsook dress. Baby fully dressed. 



Fig. 13. 




Baby dressed to go out, with sensible cloak with capes, and cap with very little 
trimming, with wadded silk cap underneath white muslin one. 



THE CHILD. 93 

separately. But from band to dress, the child 
should be turned over once only, and all done 
rapidly, causing as little irritation as possible. 
The simplicity of an infant's clothing cannot be 
too great. The needle-work may be as fine as 
possible, but ruffles, puffs, embroideries, and, 
above all, much starch, cannot be too strongly 
deprecated in the wardrobe of the modern baby. 
(Figs, ii, 12, and 13.) It is advisable to have 
a light woollen wrapper or dressing-gown, 
which can be quickly slipped on a child on 
taking it up at night or in carrying it from 
room to room ; also light knitted blankets 
which can be easily washed are very useful. 
As soon as the child is able to sit up of 
its own accord and shows desire to use its 
legs for more than simply kicking, it should be 
put into short clothes, although the time of 
year and the climate must largely govern the 
change. It would be very unwise in a cold 
climate to shorten a child's skirts in midwinter, 
for example ; but it is possible to make the 
change without risk before the winter begins. 
It is well to do so, rather than to keep the 



The writer is indebted to Messrs. J. B. Sheppard & 
Sons, 1008 Chestnut Street, Philadelphia, for the use of 
the clothing photographed for these illustrations. 



94 MOTHER AND CHILD. 

child hampered by long skirts until the fol- 
lowing spring. When the child's clothes are 
shortened, it is necessary to put on stronger 
foot-covering than knitted socks. For the be- 
ginning, there are pretty, comfortable little 
leather moccasins, and for a later period there 
are good broad-soled shoes. The greatest 
care should be taken in the selection of chil- 
dren's shoes, as their walk, their feet, and 
oftentimes their general health, are influenced 
by ill-fitting shoes. Corns are sometimes 
found on the feet of very small children, which 
by a little care might have been avoided. The 
heels of a child's shoes should be small, cor- 
responding to the size of the foot. (Fig. 14.) 
Good clothing for infants is made of care- 
fully-selected material. So much difficulty is 
experienced by the shrinking of woollen 
material, that combinations of wool with silk 
or thread have been made for this purpose. 
These have the advantage of being light in 
weight, soft in texture, and washing well. The 
number of garments needed for cleanliness is 
of the greatest importance. That is the chief 
expense ; although, of course, there is no limit 
where means are ample. 



Fig. 14. 




Model of best shoe for child's foot, — narrow heel, broad toe. For child not 
walking, buttoned shoe is most easily put on. After a child begins to walk, the 
laced shoe is better, with the same model, — narrow heel and broad toe. Model of 
shoe kindly loaned by Mr. W. H. Steigerwalt, 1015 Chestnut Street, Philadelphia. 



THE CHILD. 95 



CHAPTER III. 



THE CHILD'S FOOD. 



Formation of Milk. 

The natural food of the new-born child is 
the milk of the mother. This is gradually 
formed in the breasts, the time of its produc- 
tion varying with different individuals. With 
some patients fluid is present in the breasts in 
the early part of pregnancy. With others the 
milk is not formed until several days after the 
birth of the child. 

Milk is a fluid which in all animals under- 
goes gradual but important changes. • It is a 
living tissue, much like blood in many of its 
characteristics, and is first formed very grad- 
ually from the individual cells of the mammary 
glands or breasts. The fluid usually seen in 
the breasts at the time of labor, or soon after, 
is not fully-formed milk, but is called " colos- 
trum." It is composed of water with imper- 
fect milk-globules and young cells from the 
glands of the breasts. Colostrum has little 
nutritious value, but is useful as a natural 
laxative to empty the child's bowels. Before 



96 MOTHER AND CHILD. 

birth, there accumulates in the child's intes- 
tines mucus and other material which must 
be thoroughly removed before the child's di- 
gestion can actually begin. A laxative is re- 
quired, and this is furnished in the colostrum, 
which is the first fluid formed in the breasts. 
The emptying of the child's intestines pre- 
pares it for the digestion of the nutritious 
fluid, and the milk is formed in from two to 
four days after the birth of the child, when it 
is ready to receive and digest it. 

The secretion of fully-developed milk is at- 
tended in some cases by considerable discom- 
fort and disturbance, while in others the milk 
forms so gradually that little inconvenience is 
felt. Colostrum is a thin, watery fluid, often 
slightly yellowish in color, and does not resem- 
ble fully-formed milk. When milk is completely 
formed it is of a bluish-white color, leaving upon 
the side of a glass a distinct trace, and when 
put aside affords a considerable percentage of 
cream. The quantity formed in twenty-four 
hours depends upon the health of the mother, 
her freedom from care and anxiety, the char- 
acter of her diet, and the stimulus which the 
breast receives from the nursing of the child, or 
the absence from stimulus if the child does not 
nurse. The composition of breast-milk varies 



THE CHILD. 97 

with the mother's diet and with the exercise 
which she takes, or her lack of exercise. In- 
digestible articles of food cause the formation 
of irritating compounds, which may make the 
milk exceedingly irritating to the child. In 
some cases severe mental emotion has been 
followed by the formation of poisonous com- 
pounds in the milk which have caused serious 
injury to the child. As the milk resembles 
the blood so closely, it is evident that anything 
which injures the patient's health must injure 
her milk, as it would her blood. 

Human Milk and that of Other Animals. 

The milk of all warm-blooded animals has 
many points in common, but differences exist 
between the milk of various species of the 
animal world. The milk of the cow is that 
most often compared with human milk, be- 
cause most available for the artificial feeding of 
the child. The difference consists essentially 
in the fact that the milk of the cow is consid- 
erably richer in caseine or cheesy material than 
is human milk ; hence the milk of the cow 
requires dilution or modification before it can 
be safely given to a child. 



98 MOTHER AND CHILD. 

When Shall the Child Take its Food? 

There is a natural tendency on the part of 
mothers to give the child nourishment as soon 
as it is born, and this is based upon the belief 
that the child requires nourishment at once to 
maintain its strength and vitality. In many 
cases, however, where the mother has a severe 
delivery, she may be in no condition to give 
nourishment to the child for a day or two after 
its birth. In other cases the child itself may 
not be ready to assimilate milk for a day or 
two after birth. Nature provides for the 
child's life by bringing it into the world with 
a supply of nutritious material in the liver, the 
marrow of the bones, and other portions of the 
body, upon which it can subsist for a day or 
two after its birth. It is a mistake to begin 
to feed the child as soon as it is born and to 
push the child's nutriment from the very mo- 
ment of its birth. Its digestive organs must 
be gradually prepared to assimilate milk, and 
nature's indication in the matter may be safely 
followed. 

When the mother is in good condition, she 
may have the pleasure of nursing her child as 
soon as she has rested after her labor. From 
this time on the child may nurse during the 



THE CHILD. 99 

first twenty-four hours, every four hours ; 
during the next twenty-four, every three hours, 
and after that every two and a half to three 
hours, during sixteen hours out of the twenty- 
four, leaving eight hours for the mother's rest, 
or being nursed but once during the eight 
hours. If other intervals of feeding are de- 
sired, the physician will make a memorandum 
of what is needed, and give to the mother or 
nurse written directions stating clearly the 
intervals of feeding. 

How Much Milk Shall the Child Take? 

It is very difficult to estimate the quantity 
of milk contained in the breast. The stomach 
of a new-born child does not hold more than 
one or two tablespoonfuls of fluid. A healthy 
infant will often take an ounce of milk in be- 
tween one and two minutes while it is nurs- 
ing. If the child nurses for from five to ten 
minutes it can readily be seen that it will soon 
take a greater amount of milk than the capac- 
ity of its stomach will accommodate. This is 
provided for by the gradual dilatation of the 
stomach and also by the regurgitation of milk 
which is so often seen. 
LofC. 



ioo MOTHER AND CHILD. 

Regurgitation and Vomiting. 

A marked difference exists between re 
gurgitation and vomiting, or emesis. By re- 
gurgitation is meant a simple overflow of the 
child's stomach when over distended. It is 
often said that a baby who regurgitates is es- 
pecially vigorous and well nourished. It is 
true that children who nurse vigorously obtain 
their food much more rapidly, and hence the 
stomach overflows very easily. We recently 
had occasion to weigh a child just before 
nursing and to weigh it after it had nursed for 
three minutes. We found that the infant had 
gained four ounces during the three minutes 
in which it had nursed. From this it may 
readily be seen how easily a child's stomach 
may be overfilled and how natural it is that 
the child should eject the surplus. 

The Curd of Regurgitated Milk. 

If one notices closely milk which has been 
regurgitated, it will be seen that the particles 
ejected are not tough and tenacious, but are 
soft and very easily separated. The mass re- 
gurgitated is also white in color and is not 
accompanied by mucus. This shows that the 



THE CHILD. 101 

milk has not undergone fermentation in the 
stomach, but that it has been almost immedi- 
ately ejected. 

Vomiting. 

When a child empties its stomach a short 
time after it has taken its food, it does so by 
vomiting, and not by regurgitation. Vomiting 
is accompanied by straining, and sometimes 
by coughing, and is very different from the 
simple regurgitation which shows an overfilled 
stomach only. Vomiting is a symptom of im- 
portance, and should be reported to the child's 
physician. 



The Curd of Vomited Milk. 

Milk which is vomited is ejected in a curd, 
and this upon examination is found to be a 
tenacious mass, yellowish in color, and not 
easily separated. It differs from regurgitated 
milk in the firmness and consistence of the 
vomited curd, in the color, and in the fact that 
the curd of vomited milk is usually very sour 
in odor and in reaction. As children rarely 
vomit, but often regurgitate, the mother 
should learn to distinguish between the two, 
and thus avoid unnecessary anxiety. 



102 MOTHER AND CHILD. 

Too Rapid Nursing. 

In some cases the child seems to take milk 
so rapidly as to overdistend its stomach and 
create colic and disordered digestion. This 
may be corrected by limiting the time during 
which the child is allowed to nurse, by taking 
the child away from the breast for a moment, 
and by compressing the nipple slightly be- 
tween the fingers to make the flow of milk 
less rapid. A child that nurses rapidly should 
be satisfied in ten minutes' nursing, with 
several pauses to interrupt the filling of the 
stomach. 

Feeble Nursing. 

Children are sometimes seen to nurse too 
feebly. When the breast is excessively en- 
gorged it is difficult for the milk to flow with 
ordinary suction. Here the fault would lie 
with the breasts, and not with the child. 
When the child is feeble from constitutional 
weakness, it endeavors to withdraw milk, and 
succeeds but partially, if at all. If the child is 
tongue-tied, or has a malformation of the 
mouth, the cause of its failure to nurse will be 
detected by the physician, and an appropriate 
remedy applied. 



THE CHILD. 103 

In cases where the breast is overdistended 
the flow of milk should be started by the use 
of the breast-pump. If necessary, the breast 
may be gently rubbed in addition. When the 
milk has started, the child may be applied, 
and it will then have no difficulty in nursing. 
Where children are too weak to draw upon 
the nipple, the milk may be extracted from 
the breasts with a pump and dropped into the 
mouth of the child with a medicine-dropper. 

Shall the Child be W&kened to be Fed? 

Mothers often hesitate to waken the child to 
feed it. It is argued that the child requires 
sleep, and that when it is hungry and should 
have food it will readily waken. If this prin- 
ciple be followed the child will frequently sleep 
through the greater part of the day, remain- 
ing awake and fretful during the night. In 
cases of illness the physician will determine 
whether the child should be waked for food, 
or whether sleep is more valuable than nourish- 
ment. In good health it is better to train the 
infant in a habit of regular feeding and to 
rouse it at regular intervals for its food. In 
this way the child and the mother obtain their 
proper rest, and the infant's digestion is 
usually excellent under such a system. 



104 MOTHER AND CHILD. 

It is often difficult to induce a child to sleep 
at night and to remain awake during the day. 
In many cases the child seems to turn night 
into day, and will positively decline to sleep 
during the night or to remain awake during 
the day. This cannot be corrected at once, 
but the rousing of the child for regular feed- 
ing is one of the best means of correcting the 
difficulty. If the child's room be kept very 
light during the day, it will assist in rousing it. 
Its baths and the changing of its clothing may 
be so arranged as to disturb it at regular 
intervals during the day. 

Importance of Regularity. 

Too much emphasis cannot be laid upon 
the importance of observing regularity in feed- 
ing. Not only is the comfort of mother and 
child greatly involved, but the child's diges- 
tion may be well established or permanently 
damaged through the observance or neglect 
of this precaution. 



THE CHILD. 105 



CHAPTER IV. 

ARTIFICIAL FEEDING. 

The question of feeding a child artificially 
is so important a matter that the physician's 
aid should be invoked before making a de- 
cision. To determine its necessity, the physi- 
cian should examine a specimen of the breast- 
milk, thus ascertaining its fitness or lack of 
proper ingredients for the nourishment of the 
child. Before nursing is abandoned, the 
mother should co-operate with the physician, 
if he thinks best, in endeavoring to improve 
the quality of her milk and to increase its 
quantity. This can be done by closely fol- 
lowing directions for diet, by taking exercise 
in the open air, by using water freely, and 
by putting the patient in the best possible 
general condition. When, in spite of such 
efforts, the quality of the milk is such that it 
does not agree with the child, and the quantity 
of the milk is deficient, there can be no ques- 
tion about the necessity for artificial feeding. 
While physicians sometimes endeavor by local 
treatment to increase the quantity of milk, 



106 MOTHER AND CHILD. 

they rely usually upon hygienic measures to 
secure this result. 

Wet-Nurses. 

It was formerly customary to employ a wet- 
nurse when the mother failed to nourish her 
child. Since artificial feeding has been better 
understood and more successfully applied, 
wet-nurses are rarely used. The objection 
to a wet-nurse is the fact that it is hard to 
be absolutely sure of her physical condition, 
while the circumstances which lead her to aban- 
don nursing her own child usually make her a 
bad nurse for the child of another. If she is a 
married woman, and her husband be living, he 
will usually interfere with her to obtain her 
wages ; while if she be unmarried, it is hard 
to avoid suspicion concerning her character. 
Personally, we do not recommend wet-nurses, 
but select them as best we can when patients 
are earnestly desirous of having them. 

Cow's Milk. 

The milk of the domestic cow is most often 
used in artificial feeding. It is believed that 
milk obtained from several cows and thor- 
oughly mixed is better than milk of especial 
richness taken from a single cow. The herd 



THE CHILD. 107 

should be sound, clean, well fed, and properly 
cared for. Experience shows that cows giving 
milk not especially rich in cream are best 
adapted for this purpose. 

Cow-stables, Barns, and Pasture. 

It is quite as important that cows furnishing 
milk for children should have clean, sanitary 
stables, and that their pastures be good, as 
that the animals themselves should be sound. 
It is impossible for cows compelled to stand 
in filth or in illy-ventilated barns to be in good 
physical condition. Unless pasture be care- 
fully selected, at some portions of the year 
weeds are found which render the milk irri- 
tating and unfit for use. A herd should have 
pure water in abundance. 

The Care o! Milk. 

While it is important to modify or prepare 
milk for the use of children, it is absolutely 
essential that such milk should be secured in a 
clean manner and that it should be kept clean 
until it is used. The cow must stand in a 
clean place while being milked. It should be 
as carefully groomed as a well-kept horse. 
The utensils and the hands and clothing of 



108 MOTHER AND CHILD. 

those who milk cows and work in the dairy 
should be thoroughly clean. While these 
precautions may be difficult to secure, parents 
should co-operate with the medical profession 
in a demand for them. In the best dairies 
they are carried out, and the higher price ob- 
tained for the milk shows the appreciation of 
the public. 

Milk must be furnished to the consumer in 
a clean, sealed, glass vessel. It must be 
delivered promptly, and until the time of de- 
livery must be kept at a reasonably low tem- 
perature. The bottles in which the milk is 
delivered must be cleansed by boiling. When 
milk is sent some distance to a consumer, it 
must be packed in ice and delivered in a small 
ice-chest. For ocean voyages or long railway 
journeys, milk may be especially prepared, 
and put into packages designed for that pur- 
pose. 

The child's milk should be placed in a 
separate refrigerator, and nothing else should 
be kept in it. Nursery refrigerators are fur- 
nished for such purpose, and some are es- 
pecially constructed for use in travelling. It 
should be secured by a good lock, so that the 
milk cannot be tampered with by those who 
do not have the care of the child. 



THE CHILD. 109 

Laboratory Modification. 

In some cases the physician will order the 
preparation of the child's milk at a laboratory. 
This takes the place of a drug-store, and the 
physician's order corresponds to his prescrip- 
tion for a drug or a medicine. Milk so 
ordered is delivered in special cases or re- 
frigerators, in bottles, each containing a meal 
for the child. The bottles are corked with 
cotton, and before the child takes the milk, the 
cotton must be removed and a rubber nipple 
placed upon the bottle. The bottles are re- 
turned to the laboratory for refilling daily. 
Under such an arrangement the mother or 
nurse has very little to do with the preparation 
of the milk. It is only necessary to warm the 
milk if it be cold, to place the rubber nipple 
upon the bottle, and to give it to the child at 
regular hours, as the physician may order. 
Milk so prepared is consequently more ex- 
pensive than milk purchased in the ordinary 
manner ; and if the patient be at some dis- 
tance from the laboratory, it may not be pos- 
sible to carry out this arrangement. 

Home Modification of Milk. 

In many cases physicians prefer to give ex- 
plicit directions to the mother or to the nurse, 



no MOTHER AND CHILD. 

and to have the milk for the child's use pre- 
pared at home. Certain quantities of un- 
skimmed milk and cream are procured, — milk- 
sugar and lime-water are often ordered, — and 
the milk is prepared in accordance with the 
physician's written directions. If these are 
expressed in ounces, the mother should have 
an ounce measure. Tablespoonfuls are often 
employed as the unit instead of ounces. 

The mother will provide herself with nursing- 
bottles, with appliances for cleansing them, 
cotton for corking the bottles, and rubber 
nipples ; a suitable thermometer and litmus 
paper are also needed. The physician's di- 
rections should be in writing, and should cover 
the number of meals, the quantity of each 
meal, the intervals of feeding, and the method 
of preparation. This last is usually expressed 
as follows : Calculating the entire amount for 
twenty-four hours, the physician directs that 
this be prepared by taking the required 
quantity of milk, cream, and water. Lime- 
water is often included, sugar of milk also. 
The entire quantity of food made by combining 
the ingredients is placed in a clean, suitable 
vessel and heated for a given number of 
minutes to a required temperature. It is then 
placed in clean bottles, corked with cotton, and 



THE CHILD. in 

put in the refrigerator until the time for feeding. 
Others prefer (and this, we think, is the better 
way) to mix the entire quantity of food in a 
thoroughly clean vessel and then to pour it 
into the number of bottles required. After 
corking the bottles with cotton, they are 
placed in water in a sterilizer, or in a pan, and 
are heated to the number of degrees ordered 
by the physician. The time during which the 
heat is applied is also carefully noted. The 
milk is then placed in the refrigerator until 
needed. 

Pasteurizing and Sterilizing. 

By these terms are meant two methods of 
destroying germs which may be present in 
milk. 

Pasteurizing. — By pasteurizing is meant 
heating a liquid to 167 F. for six minutes. 
Practically this is scalding, but not boiling, a 
fluid. By this means the bacteria most com- 
monly found in milk are destroyed, while the 
digestive and nutritious properties of the milk 
are very slightly impaired. This may be done 
exactly if a sterilizer or a vessel provided with 
a thermometer is used. If such an apparatus 
is lacking, the milk may be put into a vessel, 
set in a basin containing four or five inches of 



112 



MOTHER AND CHILD. 




Arnold sterilizer. 



THE CHILD. 



"3 



water, the whole placed upon a fire, and the 
water in the basin allowed to boil briskly. 
The milk will then begin to simmer, but should 
not be allowed to boil. This is practically 
pasteurization. (Figs. 15 and 16.) 

Sterilizing. — Sterilization requires a greater 
degree of heat, — 212 F., — which is the point 

Fig. 16. 




Interior of Arnold sterilizer. 

of boiling. Sometimes it is necessary to keep 
milk for a considerable time. When this is 
the case, it may be boiled for twenty or thirty 
minutes, and thus made completely sterile. 
Unfortunately, this process makes the milk less 



ii4 MOTHER AND CHILD. 

digestible and less nutritious, and hence is to 
be avoided whenever possible. 

Asepsis in the Care of Milk. 

The best results are obtained by the use of 
milk which is neither pasteurized nor sterilized, 
but which is absolutely clean. It is extremely 
difficult to obtain such milk, because most of 
the milk furnished passes through the hands 
of a number of persons, each of whom is apt 
to be careless in some particular. If it were 
possible to obtain fresh milk perfectly clean 
and sound, the child would thrive much better 
upon it than on milk which has been heated 
or prepared in any way. Every effort should 
therefore be directed to obtaining clean and 
sound milk. Those who purchase milk should 
demand from dairies that the milk receive the 
approval of inspectors and physicians. In 
some cities physicians interested in the care 
of children inspect the various dairies, and 
give recommendations only to those which 
they find clean. When we remember that 
scarlet fever, tuberculosis, and diphtheria have 
been conveyed by milk, .we can see how im- 
portant it is that such a source of disease 
should not be neglected. 

All persons should be exceedingly careful 



THE CHILD. 115 

in cleansing vessels in which milk is kept. It 
is not sufficient to wash them in soap and hot 
water, but the jars and bottles should be 
boiled in an alkaline solution for half an hour. 
If some of the milk becomes adherent to a 
bottle or a jar, it can be removed by shaking 
shot in the bottle half filled with hot water. 
When bottles and jars intended to contain 
milk are not in use, they should be kept filled 
with a saturated solution of boracic acid. Rub- 
ber nipples should be repeatedly boiled and 
kept in boracic acid solution. Cotton used to 
cork bottles of milk should be made sterile by 
baking. Spoons, measures, filters, and all 
utensils which come in contact with milk must 
be kept absolutely clean. An ice-chest kept 
for milk must be repeatedly cleaned with 
strong alkaline solution, left open at frequent 
intervals, and thoroughly dried. It should not 
be allowed to leak, and the wooden portion 
should be preserved from decay. 

Contamination of the milk may be suspected 
if it has a foul odor, if the child vomits it soon 
after it has been taken, or if there is the 
slightest suggestion of blood or pus in the 
milk or upon the bottle. Good milk is neutral 
or feebly acid in reaction, and if excessively 
acid it is unfit for use. 



n6 MOTHER AND CHILD. 

Mixed Feeding- 

Physicians sometimes prefer to allow the 
mother to nurse the child partially, completing 
the amount of the child's food by the use of 
cow's milk. This is often spoken of as " mixed 
feeding." In such cases it is customary to 
allow the mother to nurse the child at night 
and in the morning, reserving the artificial 
food for the middle portion of the day. Thus 
the mother is enabled to go out, while the 
child has the advantage of its most digestible 
food before the time for its sleep. In these 
cases the precautions to be taken in the prep- 
aration of bottles, etc., are the same as those 
in cases in which the child is artificially fed 
entirely. 

Feeding as Children Grow Older. 

Nature indicates a change in the child's 
food as the teeth appear. It is no longer 
necessary to confine the child's nourishment 
to liquids, but food may be taken which will 
give the child some use for its newly-forming 
teeth. Parents are often in haste to stop 
liquid food and begin mixed feeding. Un- 
less a child is extraordinarily robust and 
leading an outdoor life amid the best condi- 
tions, it is well to be slow and cautious in 



THE CHILD. 117 

changing from a liquid to a mixed diet. This 
should never be done without the sanction of 
the child's physician. 

Bread. 

The first step in a mixed diet is usually the 
substitution of bread and milk for milk only. 
Cereal preparations are combined with the 
milk which the child takes from the bottle, and 
the child is given a number of bottles and one 
meal of bread and milk during the day. In 
selecting bread for children's diet, it must 
always be thoroughly baked and should not be 
strictly fresh. In fact, bread which has been 
baked several times is often found advan- 
tageous in these cases. Thus zwiebach — as 
its name implies, " twice baked bread" — is 
very easily digested. So good wheat bread, 
whole-wheat bread, graham and rye mixed, 
and zwiebach should be chosen. Some chil- 
dren will easily digest freshly-made toast if it 
be soaked in milk or in broth and the crust 
discarded. Physicians often order that bread 
be freely buttered, so that children may obtain 
the advantage of the fat. 

Gruels and Jellies. 

One of the most valuable additions to milk 
in the feeding of children is gruel or jelly. 



n8 MOTHER AND CHILD. 

This may be made from oats, barley, rice, 
wheat, or arrow-root. Those most frequently 
used are oat, barley, rice, and arrow-root 
jellies. By gruels we mean a thin mixture 
made by boiling grain or flour, and, if required, 
straining. By jellies we mean the nutritious 
properties of the grain obtained by prolonged 
boiling until the greater portion of the water 
has evaporated and the jelly forms, as its 
name implies, in a thickened condition. We 
prefer the jellies made from grain to gruels 
made from flour. Properly made jellies are 
homogeneous, without sediment, smooth, and 
exceedingly nutritious. Their mode of prep- 
aration may be obtained by reference to the 
Dietary appended to this book. Such jellies 
contain albumen in considerable quantities 
and other very digestible substances derived 
from the starchy portion of the grain. These 
jellies may be mixed with milk in the proper 
proportion, and may be salted or sweetened 
with sugar of milk as the physician may direct . 
They should be prepared by a reliable person, as 
it requires patience and attention to make them 

properly. 

Broths and Soups. 

With robust children or those recovering 

from wasting disease broths and soups are 



THE CHILD. 119 

often used in mixed feeding. Those most 
frequently selected are chicken, mutton, and 
veal broth. Their preparation is described in 
the Dietary. As with the jellies made from 
grains, these broths must contain a large per- 
centage of nutritious matter. Ordinarily made 
chicken broth is a watery concoction of little 
benefit in feeding a child. Meats for broths 
must be carefully selected, and should be ab- 
solutely sound. A vegetable stock may be 
employed to advantage, unless the physician 
orders otherwise. As broths decompose 
rapidly in hot weather, they should be used 
as soon after making as possible ; and if the 
effort is made to keep them, they should be 
kept upon ice in thoroughly clean vessels. 
Children usually prefer well-salted broths. 
Pepper and other condiments should be 
avoided in broths used by children. 

Beef Juice. 

The juice of beef has practically superseded 
beef tea and beef broths in the practice of 
physicians. Beef juice is so superior in nu- 
tritiousness, and so easy of preparation by 
intelligent persons, that it forms a valuable 
addition to our diet-list. Its preparation is 
described in the Dietary. Care must be taken 



120 MOTHER AND CHILD. 

to select good beef, and that the juice be used 
immediately after it is prepared. By experi- 
ence the child's care-taker can estimate the 
amount required at a feeding. In this way 
the beef juice is prepared freshly. It is so 
rich in nutritious elements that it cannot be 
taken frequently nor in very large quantities. 
Beef juice is sometimes added to the child's 
bottle of milk, in accordance with the phy- 
sician's orders. 

Purees. 

A valuable combination of milk and vege- 
table albumenoids is obtained in purees. 
These are most useful during the times of 
the year when fresh vegetables are abundant. 
Peas, beans, and corn are especially suited for 
these preparations. They should be made 
with great care, properly seasoned with salt, 
and may be taken from a nursing-bottle or 
from a cup. The milk contained in them is 
thoroughly sterilized by the cooking, and these 
purees form a practically sterile and excellent 
article of food. 

Junket and Custards. 

Milk curdled by rennet and eaten with 
cream and a little sugar is often very palata- 
ble to children. Custards without excessive 



THE CHILD. 121 

sugar are useful in the mixed diet of early 
childhood. Rice, custards, or rice-puddings, 
blanc-mange, sago, or tapioca, and bread- 
puddings are also relished by children who 
have advanced sufficiently to use a mixed 
diet. Sponge cake and milk form a very ac- 
ceptable combination. 

Children are usually given an Ggg before 
they are allowed to eat meat. Eggs so used 
should be absolutely fresh and soft, boiled or 
poached. Bread or toast should be taken 
with the Ggg, and stewed fruit if ordered. 

Meat for Young; Children. 

The mistake is frequently made of giving 
meat to a young child before it is prepared to 
digest and assimilate it. A child should be 
well advanced, with abundant teeth and sound 
digestion, before it is allowed to eat meat. A 
young child may suck a smooth chicken bone 
or a chop bone to advantage, thus obtaining 
the fat and nutritious material from the canal 
of the bone. 

Fruits. 

Fruits form an important part of the dietary 
of young children. The juice of fruit may 



122 MOTHER AND CHILD. 

first be used. The juice of a ripe orange in 
season is often greatly relished and is very 
beneficial. The juice of stewed prunes or of 
stewed dried peaches may also be given. 
These should be of the best quality and 
thoroughly and carefully cooked and without 
an excess of sugar. As the child grows older 
it may take the pulp of an orange or the pulp 
of prunes without the stones and skins, or 
thoroughly soft stewed peaches. The pulp 
of a baked or a stewed apple will be found 
acceptable. Berries are not suitable for young 
children ; and peaches, pears, and apples may 
be cooked and used to advantage during the 
hot months of summer, if the child's digestion 
be easily disturbed. Many children who can- 
not digest raw fruit will enjoy and are bene- 
fited by cooked fruit. Preserves, jellies, jams, 
marmalades, and sugared fruits are inferior to 
the fruits which have been described, as they 
all contain an excess of sugar. Very acid 
fruit should not be given to children, and un- 
ripe or partially spoiled fruit should not be 
used under any circumstances. 

Sweets. 

It is often said that children wish for large 
quantities of sweets. This idea is more fancied 



THE CHILD. 123 

than real, although children relish a moder- 
ate amount of sugar or syrup. They should 
be given it, if required, in their food or occa- 
sionally in a small quantity of chocolate. 

Beverages for Children. 

It is a great mistake to give a child tea and 

coffee because its parents take them. Pure 

water, milk, and thin cocoa are the beverages 

suitable to childhood. There can be no worse 

practice than giving a growing child sips of 

tea and coffee when it is at the table with its 

parents. Alcoholic beverages are unnecessary 

in childhood, unless some especial indication 

develops. During childhood the nerves are 

particularly sensitive to the action of alcohol, 

and hence it should be carefully excluded from 

the diet. 

Solid Food. 

Parents often inquire eagerly how soon the 
child may take solid food. The answer to this 
question must come from the physician, and 
he will be guided by the weight, vigor, and 
general development of the child. The first 
solid food employed is usually egg ; some 
physicians recommend baked potato, and oc- 
casionally the white meat of chicken or turkey. 
Poached eggs, prepared just before the child 



124 MOTHER AND CHILD. 

takes the food, are usually best for a beginning 
of solid diet. The egg should be salted, and 
the child may take it with bread and butter. 
If meat be given, it should be cut into small 
pieces, as children are sometimes in danger 
of choking from too large a piece of meat or 
of bread. Physicians who value the potato 
highly in children's diet direct that it be taken 
as soon as possible after being thoroughly 
baked, finely mashed with butter and salt, or 
with milk, butter, and salt. 

To allay the restlessness of teething children, 
they are often given a chicken bone or a chop 
bone, so that they may use the coming teeth 
freely by biting upon it. Splinters must be 
carefully removed from bones given to a child, 
lest it suck off and swallow a splinter, with a 
possible very bad result. 

Vigorous children are sometimes allowed to 
eat a ripe apple raw, peeled and with the seeds 
and the core removed. If the child's digestion 
is not strong, this may produce colic and dis- 
tress, and it must therefore be limited to well 
developed children only. 

Conditions which Favor a Child's Nutrition. 

We sometimes see children who are care- 
fully and properly fed, but who do not gain in 



THE CHILD. 125 

weight and are apparently not well nourished. 
There is more to be considered in the nourish- 
ing of the child than the choice and prepara- 
tion of its food ; and if other important factors 
are neglected a good result may not be 
obtained. 

We have spoken of the importance of regu- 
larity, and too much emphasis cannot be laid 
upon this point. Next in importance may be 
considered the general condition of the child 
at the time when food is taken. A child that 
is irritated, angry, and distressed, very cold or 
very hot, cannot assimilate food, no matter how 
perfectly prepared and how correctly chosen. 
Here the tact and good judgment of the nurse 
is of the greatest importance. The child's 
life must be so ordered that its meal-times 
succeed a period of rest, and that the times for 
feeding are not disturbed by useless compli- 
cations. To secure this result strictness is 
necessary in the child's life, and at first sight 
it may seem a harsh and unnecessary pre- 
caution to put aside all else for the animal 
wants of the child. A happy medium is to 
be sought, and the mistake is more apt to be 
made on the side of laxity than on the side of 
strictness. Excitable and irritable children, 
hard to feed, require strict regulation of their 



126 MOTHER AND CHILD. 

daily lives ; and this strictness does not lie so 
much in what is done to the child itself as in 
preventing those things which irritate and 
annoy a child. What grown person would 
like to be taken immediately after a meal and 
actively shaken or pounded upon the back 
while some unmeaning words are rapidly 
recited in a loud and disturbed voice ! And 
yet this is often done with an unfortunate 
infant who is suffering from colic or indigestion. 
The human animal is no exception to the rule 
seen among other animals, — that repose, or 
at least comparative quiet, should follow the 
taking of nourishment. 

The most difficult matter to regulate in 
nourishing a child is not the child, but those 
interested in it. Through kindness each rela- 
tive or friend feels moved to suggest some 
modification or change of food, while most 
persons have no hesitation in disturbing the 
child's rest or food for the purpose of inspect- 
ing it or playing with it. While a strong child 
may bear such interruptions without much 
harm, in the case of children difficult to 
nourish the result is disastrous, and care and 
tact are required to protect the child from its 
friends. 

The influence of air and sunlight cannot be 



THE CHILD. 127 

neglected in the nourishment of children. 
Fear is sometimes expressed lest the child 
taken into the open air after feeding should 
drop asleep. No better thing can happen to 
a child than to sleep properly protected in the 
open air in bright clear weather. It should 
be protected from the wind and shaded from 
excessive heat ; but in cool weather the rays 
of the sun should be allowed to fall directly 
upon its body, only the face being shaded. 
Gentle massage also promotes nutrition in 
children, as it does in adults, and takes the 
place of more active exercise. The limbs of 
the growing child must be free to move, and 
thus exercise will be secured by the child itself. 

Personal Influence in Nourishing Children. 

It is sometimes observed that a child which 
does badly under the care of several persons, 
as in an asylum or hospital, will, when removed 
from the institution and given to the care of 
one kind and loving person, immediately do 
better. While a large part of this improve- 
ment will be due to the physical conditions 
obtained after removal from the hospital, a 
considerable element in the gain must be 
ascribed to the influence of the one care-taker. 
What is called "mothering" a child is often a 



128 MOTHER AND CHILD. 

most important factor in its well-being. While 
the tact suggested by affection is better than 
professional skill in some cases, the best 
results are seen where both are combined. 
The nurse who is fond of children will do more 
for them than one who is not ; and those who 
have not the advantage of training can sup- 
plement a natural fitness by intelligent obser- 
vation, and thus become successful in this 
branch of work. 



CHAPTER V. 

AIR AND EXERCISE. 



No child can be healthy who does not have 
abundant fresh air and proper exercise. In 
changeable climates, and especially in cities, it 
is hard to obtain these. The attempt some- 
times resolves itself into taking considerable 
risk to secure a decided and positive benefit. 
During the warm months of the year fresh air 
is obtained with comparative ease. In hot 
weather the early morning and the early even- 
ing give sufficient coolness to invigorate a 
young child. During the middle of the day 



THE CHILD. 129 

the external atmosphere is too hot for safety. 
During the winter months parents are often 
afraid to send children out of doors lest they 
take cold. " 

Catching Cold. 

The term " catching cold" is commonly used 
to describe several conditions. A simple ca- 
tarrh following exposure to cold is almost in- 
evitable and not dangerous. It results in 
slight running at the nose and possibly a 
transient cough which disappears in a few 
days. When the child inspires infected dust, 
and when the weather is not only windy and 
dusty, but cold, more serious conditions are 
apt to develop. Germs capable of producing 
blood-poisoning when introduced into a cut or 
wound may enter the mouth or nostrils through 
inspired dust. The germs of tuberculosis 
blow about the streets from the dried sputum 
of tuberculous patients. Germs of other dis- 
eases are also found in street-dust and in 
the dust of public buildings and crowded 
rooms. A cold, windy, dusty day exposes the 
child first to the simple catarrh which often 
follows the breathing of cold air, and then to 
the germs of diseases which find a favorable 
soil in catarrhal mucous membranes. 

9 



i 3 o MOTHER AND CHILD. 

Exchanging Diseases. 

An unavoidable danger in sending children 
out in towns and cities is the acquiring of con- 
tagious diseases from other children. Child- 
nurses invariably talk together in streets and 
parks, comparing children under their charge 
and incidentally allowing a child recovering 
from whooping-cough to give it to another 
child, or a child recovering from scarlet fever 
to present this disease to an acquaintance. 
Parks and public squares in cities are ex- 
changes for children's diseases, and the usual 
policeman upon the spot facilitates the ex- 
change by attracting the various child-nurses 
who may be passing. 

Heat and Cold. 

If the air be pure a young child can bear a 
considerable degree of heat or cold without 
injury. Dry cold and dry heat are far less 
dangerous than heat and cold accompanied 
by a high degree of moisture. In cold weather 
sunshine adds greatly to the stimulating in- 
fluence of the air and removes much of its 
danger. Even in hot weather, if the sun is 
not allowed to fall directly upon the child, 



THE CHILD. 131 

sunshine is preferable to great heat with much 
moisture and a clouded sky. 

How Shall the Child go Out? 

An infant usually takes its first outing in 
the arms of its nurse in a carriage. If the 
weather is cold, in addition to its house cloth- 
ing, a suitable cloak and cap should be worn, 
with mittens for the hands and woollen or fur 
overshoes for the feet. In addition the child 
may be wrapped in an afghan or blanket and 
held in the nurse's arms. 

When the child is a little older it goes out 
in its own carriage. There are good and bad 
carriages for children. The best are strongly 
built, with good springs, and wheels with rub- 
ber tires. The top fits well over the carriage, 
and may be thrown back if desired. The car- 
riage must be large enough to allow the child 
to recline comfortably, at full length if desired. 
The top should fit tightly about the sides, for 
use in cold weather. We are not favorably 
impressed by many of the carts in which 
young children are taken out, for they are 
placed in a semi-sitting posture and fastened 
with a strap. As a result the child is jolted 
considerably and receives but little support 
from the cart. We have seen young children 



1 32 MOTHER AND CHILD. 

much fatigued and very uncomfortable in these 
carts. When the child grows old enough to 
sit up in the carriage there will be no difficulty 
in raising it to a sitting posture by the use of 
suitable pillows or cushions. 

Where Should the Child Go? 

In cool or cold weather the child should go 
in the sunshine, if possible. In cities the 
sunny side of a street should be selected, and 
the wider the street the better. If a square 
or park be chosen, the child will do well to 
avoid others if contagion is feared. It must 
also be remembered that a child recovering 
from a contagious disease should avoid others 
through fear of contamination. Occasionally 
in a city a long bridge or an open plaza is 
available as an airing-place. It is better to 
take a child to such a place and to shelter it 
from the wind by extra wraps than to give it 
air which is impure and not thoroughly in- 
fluenced by the sun. In the country there is 
little difficulty in finding a suitable place in 
which a child may take its air. If the ground 
be damp from snow or mud, it may be well 
to keep the child upon a piazza, and not to 
put it upon a lawn. If a child is taken for a 
drive, the dusty and dirty streets of a city 



THE CHILD. 133 

should be avoided and such localities chosen 
as have the best and purest air. 

Airing In -Doors. 

For city children it is often safest not to 
take the child out of the house except on rare 
occasions through the late autumn, winter, and 
early spring. This is done in the case of frail 
children to avoid contagion arising from in- 
fected dust or from meeting other children 
with contagious diseases. A child can be 
perfectly aired in a city house and at better 
advantage than by going upon the streets. 
To do this a room as high in the house as 
possible should be selected, and preferably a 
room which during at least some part of the 
day receives the sun. The child should be 
dressed as if for the street, the windows of 
the room widely opened, the doors closed, and 
the child placed in its coach or carried in arms 
as it would be if it went upon the street. The 
advantage of this method of airing is found 
in the fact that the air above the street is 
better than that near the surface of the ground, 
that the child is not exposed to personal con- 
tagion, nor is it exposed to strong draft if 
the doors of the room be shut. If the house 
be large, different rooms may be selected in 



134 MOTHER AND CHILD. 

accordance with the weather. If a cutting 
wind is blowing from the north, a southerly 
room is preferable ; and if a wet and rainy 
wind is blowing from the southeast, the north- 
ern room may be chosen. To succeed in thus 
giving a child air in the house patience and 
regularity are required. We have repeatedly 
demonstrated the fact that a child may be 
kept in splendid health with abundant fresh 
air without leaving its house during a winter. 
Child-nurses naturally dislike this method ex- 
ceedingly, as they do not get upon the streets 
and cannot meet their friends and acquaint- 
ances as otherwise they would do. 

Sleeping in the Open Air. 

We have already alluded to the fact that if 
thoroughly comfortable a child will naturally 
sleep in the open air. In some cases children 
have been placed out of doors at the regular 
time for their nap to secure better sleep. In 
country houses with piazzas this may be car- 
ried out during some of the cooler months of 
the year. If the child be warmly wrapped 
and placed in the sunshine it will sleep with 
great comfort and advantage. In one instance 
a child suitably wrapped and protected was 
placed in a basket upon the roof of a piazza. 



Fig. 17. 




Abdominal massage : rubbing- up the child's body along the course of the ascend- 
ing bowel. 



Fig. i! 




Abdominal massage : rubbing down the child's body along the course of the 

descending bowel. 



THE CHILD. 135 

It was sheltered from the wind, having a 
southern exposure, and slept in the sunlight 
with great comfort and benefit. This cannot 
be done without the exercise of good judg- 
ment, and cannot be trusted to ignorant or 
careless servants. Where the mother assumes 
the personal charge of her child, it has been 
done with great benefit and advantage. 

A Little Child's Exercise. 

An infant gives abundant evidence of its 
desire for exercise in the frequent rotation of 
its limbs and trunk. In feeble children, who 
especially need exercise, this should be sup- 
plemented by massage given after the morn- 
ing bath. The muscles should be thoroughly 
gone over and kneaded gently while the skin 
is thoroughly rubbed. Olive oil two parts and 
alcohol one part are useful with frail and ill- 
nourished children. Massage of the intestines 
should be included in this, especially in children 
who suffer from constipation. (Figs. 1 7 and 1 8.) 

The child's natural ambition, as it grows, is 
to get upon its feet, and here fear is often ex- 
pressed lest the child places its weight upon 
the feet too early. A healthy child will rarely 
do itself injury ; and cases in which harm has 
come from the early assumption of the erect 



136 MOTHER AND CHILD. 

posture are those in which the child has been 
placed by others upright upon its feet. If the 
child be put upon a flat, soft surface, it will do 
what its strength permits without injury, grad- 
ually raising it until finally it is almost able to 
stand. When it can pull itself up upon its feet 
by its own effort, it is usually time to allow it 
to make the effort to stand and walk. 

Most children creep before endeavoring to 
stand or walk, and this exercise requires no 
regulation, except to guard the child from 
dangerous places. In noticing the effect of 
exercise upon a child, it must be remem- 
bered that a child's legs do not seem perfectly 
straight in all cases. This does not mean that 
a permanent curvature of the bones is pres- 
ent. Usually the apparent bowing of the legs 
passes away as the child grows older and better 

developed. 

Exercise with Toys. 

Toys and mechanical devices to give a child 
exercise are sometimes useful and frequently 
have objectionable and dangerous elements. 
If a child be put in a circular stand upon 
rollers, it is tempted to remain too long upon 
its feet, as it cannot lie down. The use of 
the swing or horse requires intelligent super- 
vision and is seldom injurious. It is usually 



THE CHILD. 137 

better not to put a child in a mechanical de- 
vice which prevents its lying down or sitting 
down when it is fatigued. It would be better 
if the child were to do less and to go forward 
more slowly. 

It is questionable whether the best results 
are obtained by training a child in swings of 
various kinds. The rocking of the cradle in 
infancy may make it difficult for a child to rest 
or sleep without this motion. As the child 
grows older, some nurses try to put it to sleep 
by rocking its carriage backward and forward. 
The pleasure of rocking the child to sleep in 
the arms of the mother must not be denied 
her, but usually she can soothe the child to 
slumber, disturbing it as little as possible. 
The habit of dropping asleep quickly as soon 
as the head touches the pillow is sufficiently 
valuable to adults to justify its formation in 
childhood. In those occupations which inter- 
rupt sleep, and in times of great anxiety and 
exertion, the power to sleep quickly and qui- 
etly is an immense advantage. It is quite 
possible that incessant rocking motion may 
develop a more excitable condition of the 
nervous system than normal. It certainly is 
not necessary for health and comfort, and we 
believe may be a positive disadvantage. 



138 MOTHER AND CHILD. 



CHAPTER VI. 

THE NURSERY. 

The selection of the nursery or living-room 
for the child is a matter of considerable im- 
portance. Where a child has but one home 
for the entire year it is difficult to find in any 
one room all which is required. Thus the 
southern room in winter is delightful, but is 
too warm in summer. The child's quarters 
must often be assigned in accordance with the 
needs occasioned by climate. Where a child 
changes its home during the summer, its 
winter home should be a room with a southern 
exposure, if possible. To avoid contagion 
from sewage, there should not be in the room 
any direct communication with the drain-pipes 
of the house. It is convenient to have a bath- 
room upon the same floor with the nursery. 
An open fireplace with an open fire is of the 
greatest advantage. A furnace flue should 
not open into the room if it can be avoided. 
While the child is an infant, an open fire is 
rarely dangerous. As the child grows older 
the fire can be guarded by suitable screens. 



THE CHILD. 139 

If possible, a nursery should have smooth, 
hard walls, so that they can be washed and 
disinfected in case of a contagious disease. 
There should be as few hangings as possible, 
blinds and shades taking their place. Rugs 
should be used instead of carpets, so that 
they can be removed and thoroughly beaten 
and aired at regular times. A polished floor 
is dangerous for small children, because they 
often fall upon its slippery surface. A well- 
painted floor is less objectionable. The colors 
upon the walls and floor should be light and 
thoroughly pleasing, and care should be taken 
to select those paints which do not contain 
substances capable of absorption. Cases of 
arsenical irritation have been detected in 
children in nurseries whose wall-paper con- 
tained arsenical pigment. The furniture of 
the room should be simple and thoroughly 
comfortable. Iron or brass cribs and beds are 
preferable to wood, while the mattress and 
bedding should be well made and carefully 
chosen. When the child first begins to creep, 
a blanket may be spread upon the floor, and 
the child allowed to play upon it, or a bedstead 
may be put up in the room, a mattress placed 
upon it, four sticks or poles lashed to the four 
corners of the bedstead, and canvas or sheeting 



140 MOTHER AND CHILD. 

then drawn around the poles to make an en- 
closure. This prevents the child from falling 
off the bed, while being removed from the floor 
protects it from drafts. A little child often 
enjoys its play upon such a bed with safety. 
It is well to hang upon the walls of nurseries 
pleasing colored pictures. No one can tell 
how soon a child will notice some picture or 
toy ; and if it be surrounded by good pictures, 
properly colored, a beginning may be made 
in the development of taste. 

Ventilating and Warming the Nursery. 

During the cooler months it is sometimes 
difficult to properly ventilate the nursery. If 
the windows are lowered or raised a draft is 
feared, and without the constant entrance of 
fresh air the atmosphere of the room may be- 
come impure. A simple and good ventilation is 
obtained by a strip of board made to fit be- 
neath the lower sash of the window. The 
lower sash is raised and the board inserted, 
thus making a space between the upper and 
lower sashes. Air cannot blow though this 
space, but it can gradually enter the room. 
A better ventilator is one in which the board 
placed beneath the lower sash contains some 
device for admitting air, such as a brass pipe, 



THE CHILD. 141 

about the size of a small stove-pipe, curved 
upward, opening within the room. This con- 
tains a valve by which the volume of air can 
be regulated. A constant current of air thus 
circulates through the ventilator and the space 
between the upper and lower sashes. On 
cooler days the valve in the lower portion 
can be closed and only the upper air space 
used. If the room has an open fireplace in 
addition to such ventilators, its air-supply can 
be more thoroughly changed. Where draft is 
especially to be avoided, the use of screens is 
advantageous. Screens for a nursery should 
be made of such white or colored materials as 
can be readily washed. The frames should 
be made of hard wood, finished in light-colored 
enamel paint. Duplicate coverings should be 
made for each frame so that they can be 
washed at frequent intervals. Should a con- 
tagious disease occur among the children, the 
coverings can be disinfected by boiling, and 
the wooden portion fumigated and washed 
with an antiseptic solution. Such screens 
may seem at first costly, but if well made they 
last indefinitely, and are of the greatest service 
in case of illness among children or adults. 



i 4 2 MOTHER AND CHILD. 

Nursery Furniture and Utensils. 

The upholstering of nursery furniture 
should not be done in the usual manner. The 
chairs and couches should have cushions 
whose covers can be removed and washed and 
refilled with material which can be readily re- 
newed. Expensive and permanent upholster- 
ing should not be used in nursery furniture. 
A small table at which the children can sit is 
a great pleasure as they grow older, and 
miniature sets of furniture early teach them 
the use of such things. Enamel-ware, agate- 
ware, and especially prepared porcelain or 
earthen-ware, should be chosen for the utensils, 
if possible. In choosing toys care should be 
taken to avoid those whose colors readily wash 
off or which contain parts that may be easily 
broken or may wound the child. The best 
quality of unpainted rubber goods should be 
selected. Ivory toys have long been preferred 
for teething children, and an ivory ring has 
comforted such children for many generations. 
Modern ingenuity has provided for children 
thousands of toys where formerly but few 
could be obtained. It is interesting to notice 
that the most elaborate toys usually fail to 
interest the child. The child's taste is often 



THE CHILD. 143 

vitiated by tradition, prejudice, or fashion, and 
a healthy child usually selects some one object, 
often ugly and of little value, to which it 
attaches an affectionate interest. It would be 
well if such simplicity in taste accompanied 
the child through its later life. It is not the 
number of the child's toys, but the way in 
which it is taught to value them and its own 
healthy nature, which bring it joy. 

There should be in a nursery some recep- 
tacle for a child's toys, and the child should 
be taught to put them in order at regular 
times. The early formation of habits of regu- 
larity is well worth the trouble and attention 
necessary to bring it about. 

The Location of a Nursery. 

It is often of advantage to place the nursery 
as high in the house as possible. The noise 
which the children make in playing will not 
then annoy the adults of the family ; the air 
is better, and occasionally the child's nursery 
may in summer communicate with a roof 
where a garden is made. A summer nursery, 
or roof-garden, is of great advantage to those 
children who are compelled to remain in the 
city during the summer months. 



144 MOTHER AND CHILD. 

Nursery Education. 

The beginning of a child's education may 
be made with great advantage in the nursery. 
It is not necessary to institute any formal 
method of instruction, but a safe principle of 
education would seem to be the bringing out 
and development of the natural qualifications 
of the child. It is of primary importance that 
the child be surrounded by those who are 
habitually kind, gentle, and honest. Such 
persons are difficult to find in any walk of 
life ; and no greater mistake can be made 
than to place a child in the custody of a care- 
taker who is dishonest, ill-tempered, or re- 
vengeful. Such a person will teach the child 
to deceive most successfully. 

The regularity which should be practised in 
the nursery has an educational influence upon 
the child. As it learns that its wants are sup- 
plied at a regular time, it soon becomes ac- 
customed to an element of regularity and 
reliability. If the child is not indulged when- 
ever it cries, it soon learns the value of self- 
control. Regularity and self-control are large 
factors in forming discipline, and thus, uncon- 
sciously, even the infant receives a proper 
discipline. 



THE CHILD. 145 

The child's natural impulse is to use the 
hands and feet, and this may be taken advan- 
tage of by giving the child toys that will teach 
it to construct and arrange. Such articles are 
found in great abundance in modern shops. 
The child's memory readily develops by the 
repetition of impressions, and it soon learns 
to recognize and remember the principal events 
of its life. Children very soon acquire the 
power of reason by connecting phenomena 
which influence their comtort, and in this way 
they pass gradually from a condition of ap- 
parently automatic life to the beginning of 
reason and volition. 

There seem to be two theories of educa- 
tion for children. One may be called the 
stuffing process, by which the child is made to 
resemble an intellectual sausage. As soon as 
possible the child is made to learn and com- 
mit to memory things without logical rela- 
tion, for the sake of remembering them. This 
is carried to a higher stage in the memo- 
rizing system of education adopted in many 
schools. It does not improve the power of 
original thought in the child ; it does not 
teach the child to reason, nor does it fit it in 
the best manner for the practical duties of 

life. 

10 



i 4 6 MOTHER AND CHILD. 

The other method of education is more 
difficult, but is more reasonable. It consists 
in bringing under the child's observation such 
phenomena as shall enable it gradually to 
acquire a knowledge of itself and the world 
surrounding it. The effort is made to con- 
nect the things which happen to the child, 
and thus gradually to establish a recognition 
of the sequence of these phenomena. Curi- 
osity is one of the most prominent character- 
istics of a healthy child, and all that is needed 
is to take advantage of this fact and to feed 
its curiosity with the proper material, — to 
teach it to observe and to reason. When 
these powers have been established its further 
education becomes a natural and appropriate 

process. 

Nursery- Maids. 

A most important need in domestic service 
at present is that of competent nursery-maids. 
By these we mean young women of sound 
physical and moral health, affectionate, faith- 
ful, and honest in disposition, and suitably 
trained to take care of young children. They 
must be trained in hospitals devoted to the 
care of infants. They must be selected with 
care, and instructed to bathe the child prop- 
erly, to prepare its food under the written 



THE CHILD. 147 

directions of its physician, to do the simple 
acts of nursing, and to take charge under the 
supervision of the physician and the mother 
of the child. They should wear a uniform, 
which should be repeatedly changed and 
washed. Their duties and pay should be 
definitely fixed. They should be enrolled by 
the authorities of the hospital in which they 
were trained, and if worthy they should be 
helped ; but if they should prove to be un- 
worthy, they should be immediately dropped 
from the roll. A competent nursery-maid 
should follow the trained nurse who cares for 
the mother during her confinement. The 
trained nurse, before leaving, can give such a 
nursery-maid useful hints in the care of the 
child, for each child differs somewhat in per- 
sonal peculiarities. 

The difficulty in obtaining proper nursery- 
maids is twofold. First, it is difficult to find 
suitable young women who are willing to do 
this work, because it is looked upon as do- 
mestic service. They prefer to become trained 
nurses or to go into shops and offices. When, 
however, the compensation given, the good 
home furnished, and the care which such a 
person generally receives are considered, it is 
readily seen that a successful nursery-maid 



148 MOTHER AND CHILD. 

can save more money and live better in a 
year than many women who are employed in 
shops or offices. The second difficulty lies 
with those who employ them, and is a diffi- 
culty common with mistresses of all domestic 
servants. Employers are not always reliable 
and considerate, and do not respect the rights 
and privileges of those whom they employ. 
The successful nursery-maid becomes an inti- 
mate portion of the household, and must there- 
fore be treated with the consideration which 
the delicate character of her duties properly 
performed deserves. We know of few hospi- 
tals in this country where such nursery-maids 
are trained. In each of the hospitals affording 
such training the rate of compensation which 
the nursery-maid shall receive during her first 
year in private work is fixed by the authorities ; 
and those who employ them are requested 
to observe the fundamental regulations con- 
cerning the wearing of uniforms, as in the 
course in the hospital. 

Nursery-Governesses. 

As children grow older they require differ- 
ent mental care from that of infancy ; and here 
the nursery-governess is desirable. Such a 
woman should be of sound health, kind and 



THE CHILD. 149 

affectionate in nature, and interested in chil- 
dren. She should speak the native language 
of the children correctly, and her voice and 
intonation should be gentle and pleasing. A 
knowledge of German or of French is exceed- 
ingly useful in such a person. An elementary 
knowledge of music is also advantageous. 
The nursery-governess should be able to teach 
the correct use of the child's native language, 
and if possible the use of German or French. 
If she has talent for drawing and can thereby 
help a child who has a bent in that direc- 
tion, so much the better. But most important 
will be her example of correct and gentle de- 
portment, her proper speech, and her intelli- 
gence and good sense in answering the many 
questions of childhood and in directing the 
child's inquisitive mind. 

The Manners of the Nursery. 

Deportment may easily be taught in a nur- 
sery where the child is uninterrupted by adults. 
It is far better for young children to take their 
meals in the nursery than with their parents. 
They should have their own table and service, 
which they will learn to thoroughly enjoy and 
in the use of which they readily acquire good 
table-manners. Their ambition to be with 



150 MOTHER AND CHILD. 

their parents will stimulate and encourage 
them in learning to behave properly. Their 
meals can be made thoroughly enjoyable and 
interesting, and in this way their education can 
be imperceptibly begun. 

It is sometimes urged against such treat- 
ment of children that the proper place for the 
child is with the parents, and that it should not 
be given into the custody of strangers. No 
watchful and intelligent mother gives her child 
into the care of strangers because she has a 
nursery-maid or a nursery-governess for it. 
She soon becomes aware of the character of 
the child's care-taker and she gives her child 
such companionship at proper times as to 
maintain the closest and most affectionate re- 
lations. The real motive of those who say 
that the child must be constantly with its 
parents is that the child shall amuse them ; 
and, while a child may be a valuable instru- 
ment in educating and amusing parents, still 
it has rights of its own, and it should be al- 
lowed to develop itself as well as it possibly 
can. The results of a method of education 
which treats the child as an individual, with 
separate personal rights from those of the 
parents, are exceedingly good. It is not the 
common method of education, nor is it always 



THE CHILD. 151 

the cheapest, but in the acquirement of char- 
acter, in learning discipline, in forming- habits 
of judgment and reason, and in acquiring a 
foundation for useful knowledge it is far su- 
perior to any other. 



CHAPTER VII. 

THE HEALTHY CHILD. 

It is important that the mother or care-taker 
should have a knowledge of the appearance 
and behavior of a healthy child, so that she 
may know when the child is manifesting symp- 
toms of illness. 

Color. 

In estimating the color of a child, its natural 
complexion must not be forgotten. Pale chil- 
dren naturally do not have as bright a color 
as those who have a rosy complexion. There 
is, however, a pallor peculiar to disease, often 
spoken of as earthy, or sallow ; and if this 
continue, it is an evidence of chronic ill health. 
Those parts of the face in which color is best 
estimated are the ears, the cheeks, the lips, 
and the eyelids. 



152 MOTHER AND CHILD. 

The Flesh. 

The size of the child is not so important as 
the condition of its flesh. A large, soft, flabby 
child may be far less healthy than a smaller 
child with firm, elastic flesh. 

The Eyes. 

An infant's eyes lack expression, and serve 
for little more than the reception of light. As 
the child grows older, its pupils should react 
readily to light, its eyes should be clear, but 
without a pearly and glistening brightness, and 
the lids should not be excessively thin and 
pale. There is no yellowish discharge from 
the eyes of healthy children. In cold weather 
a slight discharge of white mucus is frequent 
in the morning. 

The Mouth. 

The mouth of a healthy child is lined with 
pinkish membrane, and in several portions of 
the mouth there are pearly, grayish-looking 
bodies, which are not evidences of disease. 
The mucous membrane is soft and smooth, 
and is neither swollen nor shrunken. The 
covering of the infant's gums is practically the 
same in color as that of the other portions of 
the mouth, growing paler as the edge of the 



THE CHILD. 153 

gum is reached. The teeth are first seen as 

little lumps beneath the gum, and finally their 

edges appear as white spots or points through 

the gums. 

The Tongue. 

The child's tongue is pinkish, like the rest 
of its mouth, but very often slightly furred in 
the centre ; and in children fed upon milk, 
after taking food, there is frequently a grayish 
sediment of milk upon the tongue. The 
tongue of the healthy child is moist and moves 
readily in the mouth. 

Tongue-Tie. 

Beneath the tongue there is a little band of 
tissue which limits somewhat the motion of 
the tongue, and which may cause apprehension 
lest the child be tongue-tied. It is very rarely 
that this band is sufficiently short to interfere 
with the child's health. If the child has 
habitual difficulty in nursing or taking its 
bottle, and cannot apply the tongue to the 
nipple sufficiently close to make efficient suc- 
tion, the physician's attention should be drawn 
to it. 

The Nose. 

The child's nostrils should move gently 
during full respiration, and the nose should be 



154 MOTHER AND CHILD. 

free from a discharge of mucus or pus. If 
the child cannot breathe through the nose, the 
attention of the physician must be called to 
such an abnormality. Healthy children must 
at all times be able to breathe without dis- 
comfort when the mouth is tightly shut. 

The Abdomen. 

The abdomen of the infant is considerably 
larger in proportion than other parts of its 
body. This excess in size diminishes as the 
child grows older ; it is not an evidence of 
disease. The umbilicus, or navel, should be 
perfectly healed and should not protrude. 

The Genital Organs. 

The genital organs of children in both sexes 
should be free from redness and swelling, and 
there should be no obstacle to the passage of 
urine. A whitish or yellowish discharge from 
this region of the body is a sign of ill health. 

The Back. 

In observing the condition of the back it 
must be remembered that the spine is a mova- 
ble column, and that unless the child is ob- 
served closely it is difficult to tell whether its 
back is practically straight or is not. There 



THE CHILD. 155 

should be no essential curve either to the right 
or to the left in a healthy child. The slight 
curve in the upper part of the back and that 
in the lower portion are natural, and are not 
evidences of disease. There should be no 
tumor in the spine and no point which is evi- 
dently painful on pressure or on motion. 

The Limbs. 

The limbs of a young child should be plump, 
the flesh firm in texture, the joints not painful 
upon motion or pressure, and the movements 
of the child perfectly unrestricted. The limbs 
of an infant are not perfectly straight, but have 
a slight outward curve ; but the ankles should 
be straight, and even the arch of the foot 
should be formed in comparatively early life. 
The heel of the infant's foot is noticeably 
narrow in comparison with the breadth of its 
toes. This results largely from lack of in- 
jurious compression by bad-fitting shoes, and 
should be heeded in preparing shoes for 

children. 

Posture and Attitude. 

There is a wide difference between the pos- 
ture and attitude of crippled children and the 
habitual position of those normally formed. 
The healthy child's attitudes are those sugges- 



i $6 MOTHER AND CHILD. 

tive of comfort, and usually of health and vigor. 
The little child tries to raise itself from its 
bed and moves its back and limbs with freedom. 
When an injury occurs, the child rests the in- 
jured part by refusing to move the muscles 
which disturb it. Timid children who become 
frightened by an injury often keep a portion 
of the body almost immovable long after the 
original injury has ended. As a rule, the 
child's postures, whether sleeping or waking, 
are those best adapted to secure its comfort. 
It maintains very largely the bent or flexed 
position of its limbs and body which existed 
before its birth. In disease this position gives 
place to one indicative of pain or to the relax- 
ation which sometimes accompanies severe 

disease. 

Motions. 

While a child's motions may seem at first 
aimless, it soon learns to do certain things 
with a definite purpose. In the first days of 
its life it often shows to a remarkable extent 
the prehensile characteristics of its four limbs. 
It endeavors to grasp with the toes as well as 
with the fingers, and does not develop the use 
of the toes because the feet are hindered by the 
wearing of shoes and stockings. Free motion 
is absolutely essential to the proper develop- 



THE CHILD. 157 

ment of a child, and no system of dressing 
should be allowed to interfere with this. The 
greater the child's vigor the more free and 
strong its motions, and the contrast between 
the unimpeded motions of a healthy child and 
the lack of motion in a child severely ill is 
most striking. 

Nursing. 

A healthy child can nurse without dropping 
the nipple to breathe or to cough. Should 
this not be possible, there is some disease or 
abnormality about the child which requires 
attention. 

Swallowing. 

A healthy child swallows without difficulty, 
and without coughing or gasping for breath. 
Should this not be possible, some obstacle to 
breathing is present which demands attention. 

Sleep. 

The healthy child sleeps with its mouth 
closed, its nostrils moving gently, and that 
portion of the body between the upper chest 
and the navel moving slightly but regularly. 
The child's limbs are usually bent, and its 
body slightly inclined forward. It is not 
readily aroused, although it occasionally moves 



158 MOTHER AND CHILD. 

in its sleep. The skin should remain warm, 
but the child should not perspire while sleeping. 

Bowel Movements. 

The bowel movements of the healthy infant 
fed upon mother's milk are bright yellow in 
color, soft and smooth in consistence. A 
healthy child may have from one to three 
bowel movements in twenty-four hours. 
When the child is fed upon cow's milk, the 
stools are lighter in color, not so smooth or 
soft, and may frequently contain curded masses. 

Urine. 

In some cases the urine of the new-born 
child is practically colorless, and in many it 
leaves a brick-dust stain upon the diaper. 
This color should pass away in a few days ; 
the child's urine should become entirely clear, 
and, as it grows older, of a light straw or 
yellow color. A very highly-colored urine, a 
dark-colored urine, or a urine absolutely with- 
out color indicate an unhealthy condition of 
the child. 

Weight. 

It is of the utmost importance that chil- 
dren should be weighed at regular intervals. 
The average healthy infant should be weighed 



THE CHILD. 159 

once weekly ; but if the child is feeble, and 
especially if there is difficulty in its feeding, it 
should be weighed more frequently, as the 
physician directs. The weight should be kept 
in a record at home, and reported to the 
physician as he may desire. 

Authorities agree that a healthy child dur- 
ing the first two months should gain from one- 
half to two-thirds of an ounce daily. This 
makes an average gain of four ounces weekly. 
The gain is somewhat proportionate to the 
weight of the child at birth, and a girl should 
gain as much as a boy. The weight of a child 
at birth is doubled at five months in healthy 
children, and becomes three times as great at 
fifteen months. The weight of a child at the 
end of one year should be doubled when it 
is seven years old, and the weight at that age 
should be doubled when it reaches puberty at 
fourteen years of age. Statistics show that at 
the end of one year a healthy child should be 
twenty-eight inches long and should weigh 
twenty pounds. This is the average weight, 
and variations may occur while health con- 
tinues. During the second year a child gains 
about six pounds, during the third year about 
four and one-half pounds, and during the 
fourth year about four pounds. Children 



160 MOTHER AND CHILD. 

grow more slowly in weight from the fifth to 
the eighth year, then more rapidly to the 
eleventh year, and from the eleventh to the 
thirteenth years girls gain faster than boys, 
and after this time boys increase more rapidly 
in weight than girls. 

Correct Scales. 

It is also important that proper scales be 
provided. A scale with a wicker receptacle 
or basket for weighing an infant is most con- 
venient, and such can be procured sufficiently 
strong to weigh a child for the first few months 
of life. When the weight of the child exceeds 
the capacity of such a scale, there can be had 
what are termed bath-room scales, which will 
weigh accurately up to one and two hundred 
pounds. Scales used for weighing infants 
must indicate ounces and fractions of an ounce 
with accuracy. Scales used for older children 
need not weigh smaller quantities than one 
ounce. 

An infant need not be divested of all its 
clothing while being weighed, but care should 
be taken to afterwards deduct the weight of 
the clothing. The child should invariably be 
weighed in the same clothing, as an accurate 
comparison is thereby obtained. We must 



THE CHILD. 161 

again urge the necessity for parents and 
nurses to co-operate with the physician by 
weighing children at regular intervals. There 
is no test so satisfactory regarding the success 
or failure of an infant's food and its general 
good health. 

Conditions Influencing the Weight of a 

Child. 

A child will sometimes gain steadily in 
weight, and then without apparent cause cease 
to grow heavier. A most frequent element 
in producing this cessation of weight is in- 
crease in length. Few children gain in weight 
while growing rapidly in length ; and if a 
child is found to be increasing rapidly in 
length, it is quite a sufficient explanation for 
its failure to gain in weight. A healthy child 
properly fed does not lose in weight, and if it 
does not gain, its weight remains unimpaired. 

Weight at Birth. 

The average healthy infant weighs about 
seven pounds at birth. Male children weigh 
a little more than females. Frequently a well- 
nourished male child weighs eight pounds. 
Excessive development is sometimes seen in 
children, bringing the weight up to ten, twelve, 



ii 



162 MOTHER AND CHILD. 

and even fourteen pounds, but such cases are 
exceedingly rare. 

Length. 

The average healthy child is twenty inches 
long at birth. This measurement is taken 
from the top of the head to the heel. During 
the first and second months the average in- 
crease is from one to two inches. From the 
third to the fifteenth month it is about half an 
inch. During the first year the child grows in 
length eight inches, which is its greatest in- 
crease in length. During the second and 
third years it grows from three to three and a 
half inches, and grows less than three inches 
during the next three years. In six years 
the original length is nearly doubled ; in four- 
teen years the final length has been attained, 
lacking a very small fraction. Girls exceed 
boys in height at the twelfth and thirteenth 
years. 

Dentition. 

The appearance of teeth marks the physi- 
ological development of the child and is an 
indication of its general strength and nutrition. 
It must be remembered that the growth of 
teeth begins during the early period of intrau- 
terine life, and that their appearance does not 



Fig. 19. 



oOOo N 



-W- 



Appearance of mouth at about 
seventh month. 



Appearance of mouth at about tenth 
month. 




Appearance of mouth at about fifteenth month. 




Appearance of mouth at about twenty-fourth month. 




Appearance of mouth at about thirtieth month. 



THE CHILD. 163 

indicate a sudden formation, but is the result 
of gradual processes in the child's nutrition. 

Teeth appear in groups and at various 
periods in the child's life. They are divided 
into the temporary, or, as they are sometimes 
called, " milk teeth," and the permanent teeth. 
The order of their appearance is variously 
stated by different students of the subject. 
The first to appear are the two lower central 
incisors, which come about the seventh month. 
Following these are the upper incisors, which 
appear during the first year. At fifteen months 
the two latter incisors and the four molars, 
which are in front, are usually visible. Be- 
tween a year and a half and two years the 
four back teeth, or molars, make their way 
through the gum. It is thus seen that nature 
takes periods of three or four months for 
bringing the teeth through. The last eight 
of the twenty teeth come three months after 
the others, thus giving the child a chance to 
rest and to have its digestion well established 
after obtaining the greater portion of its first 
teeth. The child usually has six teeth when 
one year old, twelve teeth at eighteen months, 
sixteen teeth when two years old, and the full 
twenty when two and a half years old. 



164 MOTHER AND CHILD. 

The Second or Permanent Teeth. 

The earliest of these to come are the first 
molars. The remaining teeth of the perma- 
nent set appear in much the same order as the 
first teeth. They gradually encroach upon the 
blood supply of the temporary teeth, causing 
them to loosen and fall out. 

Dentition and Development. 

Considerable variations are not uncommon 
in the coming of teeth, and alarm should not 
be felt if teeth do not appear exactly in the 
usual order, so long as the child's general con- 
dition remains good. Variations in dentition 
must be reported to the child's doctor, and his 
examination will determine whether a change in 
the food is desirable, or whether some other 
details in the child's hygiene require alteration. 
It is much too common to ascribe the illness 
of children to the coming of teeth. During 
the period of development in which teeth 
appear children often have disturbance of the 
digestive organs, take cold easily, and are 
more liable to disease. In some children the 
coming of teeth causes acute nasal catarrh, 
cough, and general restlessness and irrita- 
bility. In well-nourished children, with sound 



THE CHILD. 165 

and healthy nerves, teeth often come imper- 
ceptibly and without premonitory symptoms. 

Indications for the Care of Children in the 
Various Periods of Development. 

As the child passes through its various 
periods of development it is reasonable to 
believe that its food and general care should 
be varied in accordance with the growth of 
the body. It is evidently a mistake to give a 
child articles of food which require chewing 
before it has teeth of sufficient size to perform 
that function. As the teeth appear, the child 
being well nourished, its diet may be varied in 
accordance with its development. The most 
common mistake consists in giving the child 
solid food too early. As a result, indigestion 
and intestinal catarrh are set up which may 
lead to serious illness. The presence of teeth 
is only one indication for increasing the diet. 
The liquid diet of infancy should not be 
abandoned or interrupted except by the phy- 
sician's direct instructions. His scrutiny and 
judgment are necessary to determine this and 
to indicate what shall be given in its stead. 

Beginning' a Mixed Diet. 

Most physicians begin a mixed diet by 
teaching the child to drink milk from a cup 



1 66 MOTHER AND CHILD. 

and to eat bread-and-butter. If this goes 
badly, the bread is broken into milk and made 
thoroughly soft, and thus given to the child. 
If the child is vigorous, and its teeth are large 
and strong, it may be allowed to bite a well- 
baked cracker or to suck and bite upon a chop 
bone or a chicken bone from which the loose 
splinters and bits of fibre have been carefully 
removed. As the child increases in develop- 
ment its diet is usually varied by the intro- 
duction of soft eggs, sponge cake, cooked 
fruit, soups and broths, junket, gruels, and a 
few selected vegetables. Meat and other 
heavy articles of food should not be given to a 
child without the express direction of its phy- 
sician. 



CHAPTER VIII. 

THE CARE OF THE CHILD DURING ITS CRISES 
OF DEVELOPMENT. 

With some children it is impossible to ap- 
preciate any definite period of change, as 
they pass insensibly from infancy through the 
various stages of development to puberty. 



THE CHILD. 167 

Other children, more sensitive and more easily 
excited, pass through disturbances which may 
be termed the " crises of development." They 
require especial care at such times. 

The Care of the Child During Dentition. 

The child's mouth should be cleansed daily 
with a saturated solution of boracic acid, pure 
water, or whatever cleansing substance its 
physician may direct. If the gums become 
swollen during dentition, especial precaution 
must be taken to keep the mouth clean. The 
utmost gentleness must be exercised in cleans- 
ing the child's mouth. While a spray will 
moisten the mouth thoroughly, it does not 
bring away excessive secretion ; and as the 
child is too young to expectorate, such secre- 
tion is usually swallowed. To remove mucus 
from the mouth, the finger should be wrapped 
in soft, clean linen, dipped in pure water or in 
an antiseptic solution, and gently passed back 
over the child's tongue and around the sides 
and roof of the mouth. The motion should 
be from behind forward, thus removing mucus 
which may have collected in the posterior por- 
tion of the mouth. If this is done with gen- 
tleness the delicate membrane lining the mouth 
will not be injured ; but if it be done roughly, 



1 68 MOTHER AND CHILD. 

the child's mouth may be wounded and more 
harm than good result. 

Cooling substances are especially grateful 
to most children during this time. If the linen 
be dipped in ice-water and the gum be gently 
rubbed it will often give great relief to the 
child. Physicians sometimes prescribe medi- 
cines to be rubbed upon the gums at the time 
the child's mouth is cleansed. In this way the 
irritation which the teeth set up may be con- 
siderably allayed. Many children find comfort 
in biting upon a smooth, hard object. An 
ivory ring is an ancient resource in most nur- 
series and is excellent for the purpose. The 
clean handle of a tooth-brush sometimes 
answers well. By gentle friction directed 
down upon the teeth with firm pressure, the 
child is often much relieved and the tooth as- 
sisted in its passage through the membrane 
which covers it. 

If the child shows loss of appetite during 
dentition, it should not be urged to eat. For 
restlessness and irritability fresh air is the 
best remedy. Some children become consti- 
pated at this time, and others experience 
looseness of the bowels. Either condition 
should be reported to the child's doctor for 
appropriate treatment. A free flow of saliva 



THE CHILD. 169 

requires an abundant supply of bibs and clean 

handkerchiefs. The slight cough which some 

children have during teething is not serious, 

and usually requires no especial attention. 

In hot weather a teething child should be 

bathed as often as its comfort demands. It 

should be taken out of a city if possible and 

given the best general surroundings which 

can be procured. 

Should the gums become intensely hard and 

swollen, or should the child grow stupid or 

very excitable, with twitching motion of its 

limbs, its physician should be summoned at 

once. 

Beginning to Walk, 

When the child's muscles are sufficiently 
advanced to enable it to raise its body from 
the bed or the floor it tries to walk. Some 
take pride in the early walking of a child, and 
hold it upon its feet and encourage it in its 
efforts to stand. If the child is heavy for its 
age this will injure its limbs, and may cause 
loose joints, weak ankles, and bending of the 
bones of the lower extremities. It is a safe 
rule to allow a child to do what it can without 
assistance ; and if the child be placed upon a 
level surface, it may be allowed to get up as 
much as it desires. It should not be placed 



170 MOTHER AND CHILD. 

in any apparatus which keeps it in an upright 
posture until it is strong enough to be upon 
its feet without injury. It is better for the 
child to walk late than to walk early, as it can 
always learn to go about, while injury to the 
limbs requires time for recovery. 

The Development o! the Senses. 

So far as we know, the new-born child can- 
not perceive. Its eyes may receive waves of 
light, but it does not see in the ordinary sense 
of the term. Its eyes should be shaded from 
a strong light, because they are sensitive, and 
its visual powers should be allowed to de- 
velop slowly and gradually. When the child 
has learned to see, advantage may be taken 
of the fact to begin its education by surround- 
ing it with objects of graceful form and pro- 
portion and by teaching it to distinguish 
between one or more objects and gradually 
to recognize color. In selecting toys or sur- 
roundings, the precaution must be taken to 
avoid dyestuffs and color materials which 
are poisonous. Bright greens are especially 
dangerous in wall-paper or otherwise used, 
because of the arsenic which they contain. 
Painted toys are also injurious, because the 
child may suck off the paint in putting objects 



THE CHILD. 171 

into its mouth. It is impossible to tell just 
when a child begins to perceive or to dis- 
tinguish between one and several objects. 

Perception of sound is probably present 
earlier than visual power, and although sounds 
are not critically distinguished, the child soon 
learns to recognize its mother's voice and to 
distinguish pleasing from terrifying noises. 
Melody is appreciated by very young chil- 
dren, as is shown by the familiar use of the 
cradle-song. 

The sense of taste, as a reflex only, is 
present before the child's birth. The food of 
an infant is usually so bland in character that 
the element of taste need not be considered. 
Cows at pasture sometimes eat herbs and 
weeds, such as garlic, which give to the milk 
an objectionable taste. Should an artificially- 
fed child refuse its bottle, this cause must be 
kept in mind in investigating its apparent lack 
of appetite. 

The senses of touch and smell do not seem 
to be present in young children in any appre- 
ciable form. The prehensile power of the 
child must not be confused with the sense of 
touch, for the former is a reflex act only, while 
touch is a much more highly developed attri- 
bute. The temperature sense of the child, 



172 MOTHER AND CHILD. 

which is closely allied to touch, is early devel- 
oped, and it forms a valuable index to the 
child's comfort and general condition. 

In caring for a child while the various senses 
are developing, pains should be taken not to 
subject it to a sudden or violent impression 
upon any one of its senses. Very strong 
light should not be thrown upon its eyes ; it 
should not be exposed to loud and sudden 
noises. Pungent substances or powerful odors 
should be kept from the child. Extremes of 
heat or cold and violent disturbance of the 
child's nervous system should be avoided. 
The child's senses may be stimulated in the 
beginning of its education by giving it well- 
proportioned objects to look upon and by 
allowing it to hear only modulated sounds, 
thereby developing its understanding in a 
normal and proper manner. 

The Airing of the Child. 

It was formerly thought that a child must 
be of a certain age before it could be taken 
out and given fresh air. This constituted one 
of the epochs in its development. At present 
we are so convinced of the value of fresh 
air for children that we do not limit the going 
out of a child to a certain period of develop- 



THE CHILD. 173 

ment, but, in accordance with the climate, 
give it fresh air from the first few weeks follow- 
ing its birth. The manner of its airing must 
depend upon the temperature, the direction 
and velocity of the wind, the presence or 
absence of sunshine, and the facilities at the 
disposal of the parent or care-taker. 

Puberty. 

In this country the average age of puberty 
in both sexes is from thirteen to fifteen years. 
The importance of this crisis in the develop- 
ment of both boys and girls is often not 
appreciated. Each alike should be relieved 
from continuous mental strain and should as 
much as possible lead simple and healthful 
lives in the open air. In proportion to the 
intelligence of the child, its parents should 
inform it of the changes which are going on 
in its body, and teach it to care for itself prop- 
erly at this time. Children should be exam- 
ined — if this has not previously been done — 
to see that no abnormalities of the generative 
organs exist which might give rise to irritation. 
The general health should be kept in the best 
possible condition, and any abnormality should 
be reported at once to the child's physician. 
The associations of the child should be closely 



174 MOTHER AND CHILD. 

scrutinized, and it should be removed from all 
improper influences. 

Education During Crises of Development. 

Theoretical considerations in education 
should be absolutely abandoned for the physi- 
ological needs of the growing child. Its best 
education is not obtained in schools or neces- 
sarily from books. Its parents and care-takers 
should be its educators, and if they are in- 
efficient, its advancement will be retarded. 
The constant temptation is to overtax the 
child's power of memory. Memory depends 
upon the vital condition of the general nervous 
system. It is not a function of the brain alone, 
as many suppose. The child's nerves, like 
other parts of its body, are delicate and sensi- 
tive, and it can absorb impressions with great 
rapidity. Hence the constant temptation is 
to thrust impressions upon it and to have it 
learn by imitation a mass of things whose 
meaning it does not understand. 

At puberty education should be made 
secondary to the child's health for several 
years. Boys or girls, should they be delicate, 
are best out of school leading lives of healthy 
play in the open air and using their minds in 
such ways as the conditions of their bodies 



THE CHILD. 175 

dictate. It is quite enough for a child to 
read interesting books or to attend to minor 
things during this period. No requirement 
of school competition or of class standing 
should be allowed to interfere. With those 
who can do so, it is sometimes advantageous 
to change the child during this period to an 
equable climate where it can be in the open 
air during the greater portion of the day. 

During puberty girls should receive especial 
attention. Desire for rest should bring to 
them abundant repose. Digestive disturb- 
ances or anaemia should receive the physician's 
attention, and the nervous sensitiveness which 
often occurs at this time should be soothed by 
the companionship of the mother. It is much 
better for the child to have no fixed and defi- 
nite tasks, unless they occasion no strain and 
are a source of positive pleasure. The 
mother should tell the child as much about 
menstruation as will impress upon her mind 
the necessity for taking care of herself, and 
should also instruct her carefully how this 
is to be done. The foundation for good or 
bad health is laid in many cases at this time ; 
and health is so important for happiness that 
all else should give way before it. 

Puberty and the few years following are 



176 MOTHER AND CHILD. 

most important periods in the development of 
womanhood. Constricting clothing applied to 
the girl at this period of life causes uterine dis- 
placements, failures in development, and lays 
the foundation for permanent ill health. The 
mother of the girl must choose deliberately 
between fashion and health. It does not 
follow that because she declines to use con- 
stricting clothing her child will be unshapely 
and unattractive in appearance from an artistic 
sense. By adopting a system of dress which 
supports the clothing from the shoulders, 
which leaves the waist absolutely without con- 
striction, and which selects apparel in accord- 
ance with the child's personal peculiarities, 
she may be properly and attractively clothed, 
while still retaining good health. It is a ques- 
tion for the mother to determine whether she 
will consult her child's most important and 
best interests, or whether she will accept the 
dictates of those who are unwilling to differ 
from the majority. 

Moral Development During Crises of Growth. 

Parents must remember that during the 
epochs of development the sensitive condition 
of the child's nervous system makes it 
emotional and often brings out in exaggeration 



THE CHILD. 177 

traits of character. In some children excessive 
sensitiveness leads to fear ; and if the child be 
bullied by a bad nurse, it speedily learns to 
lie and to cheat. As puberty approaches, the 
development of the generative organs and the 
child's natural curiosity make it a fit subject 
for impure suggestions. It is evident that 
the moral and physical are so closely com- 
bined in development that they cannot be 
separated. Whatever may be our views re- 
garding the development of the moral nature, 
one fact remains without question, that sound, 
healthy physical development is a great aid in 
moral growth. Parents and care-takers in 
securing good health for children are thus 
laying a foundation for the development of 
sound character. 



CHAPTER IX. 

THE SIGNS OF ILLNESS IN CHILDREN. 

Those who are accustomed to observe chil- 
dren will detect signs and symptoms of illness, 
although the child cannot accurately describe 

its sufferings. 

12 



178 MOTHER AND CHILD. 

Color of the Skin. 

The child's natural color must be taken into 
account in considering whether it be flushed 
or pallid when ill. A great variation from its 
natural color, either in flushing or in pallor, is 
an evidence of disease. The more acute the 
disease the more sudden and pronounced is 
the variation from the normal color. Fever 
may be present when a child is pale, and is 
usually present when the child is flushed. 

Sallow or earthen color, yellow complexion, 
and a dusky or leaden color are also signs of 
disease. 

Eruptions. 

An eruption or breaking out upon the skin 
may be evidence of a trifling disturbance of 
health or it may be a sign of severe infection. 
Hot weather which develops quickly, indi- 
gestible food, and great nervous disturbances 
cause eruptions which are indications of the 
general state of the child's health. Infectious 
diseases, such as scarlet fever, measles, and 
the like, are accompanied by eruptions. Dye- 
stuffs used in clothing may cause eruptions 
which resemble those of disease, while the 
bites of insects and the effects of poison-ivy 
are familiar. In estimating whether an erup- 



THE CHILD. 179 

tion is a serious symptom or not, it must first 
be considered whether the child has been ex- 
posed to an apparent cause. If a child has 
been exposed to mosquitoes, mosquito bites 
are the natural consequence, and therefore not 
evidence of a serious illness. If the child has 
been playing with an animal infested with para- 
sites, it is not strange that it should show 
blotches caused by such parasites. If a child 
is too warmly dressed, as is very often the 
case in mild weather, an eruption is to be ex- 
pected. If a child eats indigestible food in 
warm weather, it is not strange that it should 
have a breaking out. When, however, an 
eruption is accompanied by depression, or by 
great restlessness and fever, it is a symptom 
of importance, and the child's physician should 
be summoned at once. 

Eruptions Caused by Parasites. 

The itch insect causes an eruption resulting 
from the presence of a parasite which bur- 
rows beneath the skin. Ringworm may be 
derived from kittens or from dogs, and causes 
a circular red eruption which is characteristic. 
Other eruptions are derived from parasites 
occasionally obtained in food or in articles 
handled by a child. 



180 MOTHER AND CHILD. 

Chronic Eruptions. 

When a child has a roughness and redness 
of the skin which does not disappear, but re- 
mains and increases, it is a symptom demand- 
ing attention. What is commonly known as 
salt rheum, properly termed eczema, is a con- 
dition of this sort. It is not uncommon in 
badly-fed children to see a chronic eruption 
of pimples, and in some cases these become 
of considerable size, dark in color, and accom- 
panied by thickening of the skin. These are 
evidences of an unhealthy condition of the 
intestines and a sluggish action of the skin. 

Fever. 

Fever is usually present in illness occurring 
in children. The degree of fever may be es- 
timated by its effect upon the child. If the 
child is stupid, dull, and evidently depressed, 
or if it be delirious and highly excitable, with 
flushed face and hot skin, the fever is high. 
Occasionally the fever is high although the 
skin is pale instead of being flushed. Fever 
is easily excited in children, and usually yields 
promptly to proper treatment. If the physi- 
cian desires, the mother may procure a suit- 
able thermometer and learn to take the child's 



THE CHILD. 181 

temperature. This should not be done, how- 
ever, unless requested by the physician in 
charge of the child. 

The Pulse and Heart Action. 

The pulse and heart action of children are 
more rapid than those of adults in good health. 
It is almost impossible to count the pulse of a 
little child, and a person not familiar with 
children would readily imagine that serious 
illness was present when such was not the 
case. If the hand be placed over the heart of 
a little child, it will be found to beat very 
quickly, although the child may be perfectly 
well. When severe illness is present the pulse 
cannot be counted and the heart-beat is very 
quick and disturbed. 

The Breathing in Health and Disease. 

We have already called attention to the 
breathing of the healthy child. The mouth is 
closed and the abdomen and lower portion of 
the chest move gently and regularly. When dis- 
ease is present, the mouth is partially or wholly 
open, the nostrils are widely dilated, and the 
chest and abdomen move in a labored manner ; 
the more severe the disease, the more dis- 
turbed the breathing. This is especially true 



1 82 MOTHER AND CHILD. 

in diseases of the lungs, when the breathing 
may be exceedingly labored. It is not so 
much the rapidity of breathing as it is the 
evident labor of respiration which denotes dis- 
ease of the lungs. 

Vomiting. 

Many diseases are ushered in by vomiting. 
Indigestible and irritating food cause vomiting. 
Fear, emotion, and excessive nervousness in 
some children produce vomiting. The empty- 
ing of the stomach is a symptom only, and not 
a disease, and should be reported to the child's 
physician as a symptom. We have previously 
drawn attention to the difference in milk-fed 
children between regurgitation and vomiting. 

Diarrhoea and Constipation. 

Very frequent bowel movements constitute 
diarrhoea and indicate disease. A child may 
remain in good health having two or three 
movements in twenty-four hours, but more 
frequent movements indicate disease. 

Constipation is a relative term, and usually 
means failure to have one movement of the 
bowels in twenty-four hours. It is possible 
for a child to remain in good health whose 
bowels do not move daily, but it is exceedingly 



THE CHILD. 183 

unusual, and the failure to secure a daily 
movement should be reported to the physician. 

The Character of Bowel Movements. 

Bowel movements vary from the soft, bright 
yellow movements of infants to the darker 
movements of older children. In disease the 
bowel movements become thin in consistence, 
offensive in odor, and the color may be green, 
blackish brown, clay, coffee-ground, and red- 
dish or bloody in color. In diseases of the 
intestines the bowels frequently contain mu- 
cus, and sometimes blood and pus. Curds of 
milk must not be confounded with mucus, 
although both are frequently present at the 
same time. Liquid stools of grayish or yel- 
lowish fluid are present in some cases of severe 
and prolonged intestinal disease. Chronic 
distention of the bowels with gas is present in 
diseases of the intestines, and is a symptom 
not to be neglected. In severe cases disten- 
tion may proceed to such a point as to seriously 
interfere with breathing and threaten the life 

of the child. 

The Urine. 

In infancy the urine is colorless and abun- 
dant in quantity. As the child grows older 
the urine becomes darker in color, and in case 



1 84 MOTHER AND CHILD. 

of acute disease may be dark yellow or red- 
dish, with an abundant brick-dust sediment. 
It is very difficult to measure the quantity 
passed by a little child in twenty-four hours. 
Should the urine be scanty, or highly colored, 
or offensive in odor, or contain a trace of 
blood, the occurrence should be at once re- 
ported to the child's physician. In very young 
children the stain which the urine makes upon 
the diaper should be noted, as it gives some 
indication of the condition and composition of 
the urine. 

The Child's Expressions of Disease. 

Although little children cannot tell in words 
what is the matter with them, their cries and 
their actions give to those who understand 
them very important information. The mother 
or care-taker soon learns to distinguish be- 
tween the cry of hunger and that of irritation 
or anger. Each of these cries is loud and vigor- 
ous, and is soon appeased. In some forms of 
disease the child's cry becomes shrieking, ex- 
plosive, and almost maniacal, while in chronic 
and more serious disease the cry ceases to be 
vigorous, and gradually subsides into a moan 
or constant ejaculation, which is very signifi- 
cant and distressing. 



THE CHILD. 185 

The child tells by its postures and attitudes 
more than by its voice. A sensitive joint or 
a painful limb is held as quietly as possible. 
The child is afraid to move it ; and if it be 
moved by another, motion is resisted and the 
child cries with pain. If there is acute pain 
and inflammation in the abdomen, the child 
lies in such posture as to keep the abdominal 
muscles as still as possible and resists motion 
with its lower limbs. In some forms of dis- 
ease of the nervous system the child arches 
its body strongly backward, contracting the 
muscles of the trunk to bend the spine strongly 
in this direction. In severe disease the eyes 
are turned in unnatural positions, the expres- 
sion of the face is altered, and the child's de- 
meanor is so different from that of health that 
no trouble is experienced in recognizing the 
presence of disease. 

The Signs of Chronic Disease. 

A sickness which becomes apparent sud- 
denly with pronounced symptoms is easily 
recognized. It is just as important to detect 
an illness developing slowly whose conse- 
quences may be quite as serious. Among the 
signs of chronic illness which should be recog- 
nized by the child's care-takers are progressive 



1 86 MOTHER AND CHILD. 

loss of weight, progressive failure of strength, 
the persistence of unnatural bowel movements, 
failure in appetite, and an irritable and excita- 
ble condition of the nervous system, or an 
apathetic and indifferent state. When these 
conditions are present, developing gradually 
but steadily, the child is chronically ill. 



CHAPTER X. 

NURSING SICK CHILDREN. 

Shall the Mother Nurse the Child? 

In cases of illness the question often arises, 
Shall the mother nurse the child, or shall a 
trained nurse be summoned ? The answer to 
this question will depend upon the circum- 
stances of the case. Sick children require 
constant attention and observation. No one 
person can give this for any length of time 
without intermission, and hence whoever as- 
sumes the care of the child must have help. 
If the mother is excitable and apprehensive, 
her presence is often a positive detriment to 
the child. The child is more easily managed 
and is less excitable during her absence. On 



THE CHILD. 187 

the other hand, there are often times during 
the illness of children when the mother's at- 
tention is most grateful and soothing. All 
trained nurses do not succeed in caring for 
children. Great patience and tact and a 
genuine and affectionate interest in the child's 
recovery are required. The physical strain is 
such that frail or old women cannot successfully 
nurse sick children, and such persons should 
not be selected for this duty. The influence 
of a young and strong nurse is especially 
good upon such patients. In our observation 
the best results are obtained by a good nurse 
and a sensible mother, a combination not al- 
ways easy to secure. The nurse should be 
given charge of the case, acting under written 
orders from the physician and representing 
him in his absence. If she has tact and sym- 
pathy, she will utilize the mother's help by 
allowing her to exercise her affection for the 
child and to give it the comfort of a mother's 
love. In severe and critical illness, whenever 
possible, two nurses should be employed. 
These nurses should so arrange their hours 
that both will be present at the doctor's morn- 
ing and evening visits. They can relieve each 
other in such a way as to secure needed rest, 
and can so help each other that manipulation 



1 88 MOTHER AND CHILD. 

and work about the child shall be done in the 
best and most comfortable manner. 

If trained nurses cannot be procured, a sick 
child is better off in a suitable hospital than 
in its home. If this is not allowed, then the 
mother must do her best and secure such help 
as is available. 

Nursing in Diseases of the Digestive Tract. 

A large proportion of children's diseases 
are those of the digestive organs, and mothers 
should be familiar with the essentials of care 
in these cases. The entrance of germs in 
impure food is the usual origin of such disease. 
Hence the first indication lies in keeping from 
the child impure food and infected water. If 
it is suspected that bad milk has caused the 
trouble, the child should not be given milk. 
It may be nourished with albumin water and 
broths until the doctor permits other food. 
The water which a child ill with digestive dis- 
ease takes should be pure ; and if doubt ex- 
ists regarding the water available, it should be 
filtered and boiled. In such cases the dis- 
charges from the bowels and also the urine 
may contain poisonous germs. If possible, 
such discharges should be received upon cheap 
material, like cheese-cloth, which can be 



Fig. 20. 



n 




Irrigating- the bowel. 



THE CHILD. 189 

burned when soiled. If this cannot be done, 
the diapers should be boiled and thoroughly 
dried before using again. The child's body 
about the opening of the bowel should be kept 
as clean as possible ; and as the discharges 
are frequently irritating, vaseline should be 
used to prevent wounding of the skin. In 
these cases the child is exceedingly thirsty, and 
an abundance of water should be given. 
Sponging with tepid or cool water, or with 
alcohol and water, is most acceptable in these 
cases. If the disease be prolonged, the child's 
mouth becomes foul and sometimes offensive, 
and should be cleansed as often as necessary. 
The mother should keep an account of the 
bowel movements and should save the napkins 
for the doctor's inspection. She should also 
notice whether the child vomits, and keep a 
record of the number of ounces of food and 
of water which the child takes. 

Physicians often prescribe in these cases 
washing out of the bowel by a soft rubber 
catheter and fountain syringe. (Fig. 20.) This 
is done by placing the child upon its abdomen 
across the mother's knee, — having filled a foun- 
tain syringe with the warm solution ordered by 
the doctor, — allowing the solution to run, and 
inserting the soft rubber catheter, well oiled, 



190 MOTHER AND CHILD. 

with a gentle rotary motion, then pushing it 
as far as it will go into the child's bowel. The 
child will first make an effort to expel the 
catheter ; but if it be held in place, it can finally 
be pushed past the point of obstruction and 
into the bowel. At least two quarts of fluid 
should be used as often as the doctor directs. 
In diseases of the digestive organs especial 
skill and care are needed in preparing the 
child's food. The mother or nurse must under- 
stand cooking thoroughly, and thus be able to 
take advantage of any sort of nutritious 
matter which the child can assimilate. The 
question of recovery often depends not upon 
medicines, but upon finding some sort of nutri- 
tious material which the child can take. 

Nursing in Diseases of the Respiratory Organs. 

As in diseases of the digestive organs, 
many affections of the throat and lungs are 
caused by the entrance of poisonous germs. 
Diphtheria and tonsillitis are familiar examples 
of infection of the throat, while influenza, 
bronchitis, and pneumonia are examples of 
infection of the lungs. 

In nursing these cases it is especially im- 
portant that the child be given a free supply 
of fresh air. All such cases should be kept 



THE CHILD. 191 

in a room ventilated by an open fire. The 
heat from a furnace flue is the worst possible 
method of warming a room for such a patient. 
An open stove, burning coal, is excellent. 
Except in severe weather, a window in the 
room should be kept partially open, and the 
child protected from direct draft by a screen. 

External applications are often employed 
in these cases. The chest and throat are 
rubbed with camphorated oil or some other 
medicine prescribed by the physician, and 
compresses and packs are applied to the chest. 
A cold compress upon the throat is frequently 
used, and is a most efficient method of treat- 
ment. The best material for compresses is 
soft flannel. Compresses should not be 
covered by oiled silk or rubber, but should be 
allowed to dry as rapidly as the heat of the 
part will permit. They should be renewed 
as soon as dry. The doctor will prescribe the 
temperature of the water from which the com- 
presses are to be wrung. Packs for the chest 
are made in the same manner, the flannel 
being sufficiently large to extend from the 
child's neck to the umbilicus. They are wrung 
out of water at the temperature ordered, 
wrapped completely about the chest, and a 
thin, dry flannel placed over them. The indi- 



192 MOTHER AND CHILD. 

cations for using them are given definitely by 
the physician in charge. Medicines may be 
added to the water out of which the compress 
is wrung. 

For use in disorders of the throat and lungs 
an artificial atmosphere containing medicated 
vapor is manufactured. A kettle containing 
a boiling solution of medicine may be em- 
ployed, throwing a vapor into the atmosphere 
of the room or into the child's crib. In some 
cases the crib is covered by a tent formed 
with blankets and the vapor thrown into 
it. (Fig. 21.) Many of the kettles employed 
for this purpose are heated by alcohol lamps, 
and especial precautions must be taken lest 
the alcohol overflow and set fire to surround- 
ing objects. Occasionally a patient is burned 
in an accident of that kind. 

In some disorders of the respiratory organs, 
such as croup, it may be desirable to produce 
free vomiting promptly. The physician will 
prescribe such remedies as may be given inter- 
nally, and their action may be aided by holding 
the child with its head considerably lower than 
its hips, and then inserting the finger into the 
mouth and irritating the throat as far down as 
possible. If the child's forehead be supported 
by the other hand of the nurse, its tongue will 



THE CHILD. 193 

drop forward and it will readily empty its 
stomach. 

In diseases of the respiratory organs the 
inhalation of oxygen is sometimes employed, 
and it should be given as the doctor directs. 
The apparatus is simple and can be readily 
used by a careful person. It is of the utmost 
importance that the child have most nourishing 
food at frequent intervals and also stimulus. 
The ingenuity of both the mother and the 
nurse will often be taxed to feed it and give it 
stimulus successfully. In some cases mustard- 
baths are given at the temperature prescribed 
by the physician. Sufficient mustard is put 
into the water to make it taste distinctly. The 
child is placed in the bath and its chest briskly 
rubbed until the body is red. It is then re- 
moved quickly, dried with flannel, and, if the 
fever be high and it is in accordance with the 
doctor's orders, a pack is placed about the 
chest. In using this method of treatment, the 
doctor's orders must be very strictly followed, 
and he will prescribe in detail the indications 
for using the bath and the method by which it 
is to be given. 

In diseases of the respiratory organs the 
mother and the nurse must remember that 
matter ejected from the mouth is often infec- 

13 



1 94 MOTHER AND CHILD. 

tious. Such a child must not be kissed upon 
the mouth, and mucus expelled from the 
mouth and nose should be received on bits of 
old linen or cheese-cloth which can be burned. 
The lips and nostrils often become distressingly 
sore in these cases and should be protected 
by vaseline or cold cream. 

Nursing in Diseases of the Nervous System. 

The nerves of young children are so sensi- 
tive that any severe illness produces consider- 
able disturbance. Fortunately, disease of the 
brain and nerves is much less frequent than 
that of other organs of the body. Many dis- 
eases formerly thought to attack the brain are 
now known to be those of the lungs or diges- 
tive organs, producing disturbances of the 
brain and nerves. In illness attacking the 
brain and nerves absolute quiet is essential for 
the patient. Sun and light must often be shut 
out as much as possible. External applica- 
tions of cold by ice-bags are frequently em- 
ployed, and in using them care must be taken 
that the ice-bags do not leak. One layer of 
thin, dry flannel between the ice-bag and the 
skin makes the application much more endur- 
able. Some prefer to cover the rubber bag 
with flannel before applying it. In addition to 



THE CHILD. 195 

the child's medicines, it must often be fed 
without its active co-operation. In some of 
these cases the child does not swallow, and 
prepared food must be inserted into the bowel. 
Medicines are sometimes rubbed into the skin 
in the form of ointments, and in chronic 
cases electricity is frequently applied to the 
child's back and limbs. 

A distressing feature in these cases is the 
delirium and crying which the child exhibits. 
The parents may fortunately remember that 
the child is not completely conscious during 
such illness. Its real suffering must be less 
than its symptoms indicate. 

In long-continued disease of the nervous 
system the pressure of the child's body upon 
the bed may cause the skin to become sore. 
Especial attention must be given to the skin 
at such points, — bathing with alcohol, applying 
pads to relieve pressure, and turning the child 
frequently into various postures. 

The Nursing of Chronic Diseases. 

We sometimes see cases in which active 
symptoms subside but the child's recovery 
lingers. In some cases there seems to be no 
one organ at fault, but the child does not re- 
gain strength or become well nourished. The 



196 MOTHER AND CHILD. 

care of such patients taxes the strength and 
resources of the mother and the nurse ex- 
ceedingly. The utmost patience and a strong 
affectionate interest in the child's welfare are 
required to continue its care. It is a great 
help for the mother if she will train herself to 
expect no rapid advance in the case from day 
to day, and will content herself in doing her 
duty and in diverting her mind as much as 
possible from the wearing features of the case. 
If she will review the progress of the child at 
intervals of a week or ten days, she will 
usually find evidence of some improvement. 



CHAPTER XI. 

INFECTIOUS AND CONTAGIOUS DISEASES. 

Shall Children be Deliberately Exposed to 
Infection and Contagion? 

It is a familiar fact that certain infectious 
and contagious diseases are constantly present 
among human beings. Measles, scarlatina, 
chicken-pox, mumps, and diphtheria are espe- 
cially apt to attack children. If a slight epi- 
demic of one of these disorders is prevalent, 



THE CHILD. 197 

and if the weather be mild and favorable, 
parents will sometimes raise the question, 
Shall a child be deliberately exposed in order 
that it may have the disease under the most 
advantageous conditions and with the least 
danger ? If we could assert positively that a 
child would have a mild attack of a given in- 
fection under certain conditions, it might be 
justifiable to allow a child to pass through an 
epidemic infection, and thus avoid the possi- 
bility of a more severe illness at another time. 
Unfortunately, we cannot foretell absolutely 
from the character of an epidemic or from the 
surrounding circumstances that a given case 
will be a mild one. Hence it is unjustifiable, in 
our belief, to expose a child deliberately to any 
contagious or infectious malady. 

On the other hand, it is unwise to attempt 
to escape these diseases. While due precau- 
tion should always be taken to avoid illness, 
yet at the same time it is absolutely impossi- 
ble in most cases to keep a child from the risk 
of contagion. 

Methods by which Contagion and Infection 
are Conveyed. 

By contagion we understand the transfer- 
ence of the active poison or principle of a 



i 9 S MOTHER AND CHILD. 

disease by touch. Thus, books and toys which 
have been used by children suffering from 
scarlatina are contagious to those who have 
not had the disease. An infectious disorder 
is one due to a particular poison whose trans- 
ference cannot always be proved, but often 
depends upon touch or contact. Mumps is 
probably contagious, and is certainly infectious, 
but we cannot distinctly recognize the manner 
in which the infection is conveyed. In gen- 
eral, however, we may say that in both infec- 
tious and contagious diseases the objects used 
by a person having the disease, such as toys, 
drinking-glasses, bedding, and toilet articles, 
may convey the germs of the disease. The 
air breathed out by a person having such a 
disease is especially apt to contain these germs. 
The discharges from the body of such a pa- 
tient should be considered as containing the 
poison causing the disease. Under these cir- 
cumstances, we can readily understand the 
conveyance of scarlatina by books, toys, or 
clothing ; the fact that measles seems to spread 
principally by the expired air from the patient 
and by the catarrhal secretions of these cases ; 
that diphtheria and other disorders of a like 
nature may be transferred by drinking-glasses, 
handkerchiefs, and towels, or by something 



THE CHILD. 199 

which has been used by or in proximity with 
the patient. 

Articles used in food may convey contagion 
and infection. Scarlatina has been carried 
in milk, tuberculosis in milk and meat, while 
the germs of typhoid fever are usually con- 
veyed by water. 

The Avoidance of Infection and Contagion, 

The principal sources of infection and conta- 
gion are public conveyances, schools, churches, 
theatres, and crowds of persons. In cities, the 
parks and squares frequented by children 
serve as depots of distribution for contagious 
diseases. As few public buildings and vehicles 
are properly ventilated, the medium of conta- 
gion is usually the air expired in such places 
by those having a contagious disease or re- 
covering from it. 

The Symptoms of Infection or Contagion. 

As these disorders are caused by a living 
poison, the symptoms announcing the recep- 
tion of this poison are primarily disturbances 
of the nervous system. The nerves which 
regulate the temperature of the body are most 
often disturbed. A chill followed by fever 
ushers in many of these disorders. The nerves 



200 MOTHER AND CHILD. 

regulating the action of the heart are disturbed, 
the pulse is usually fast, and often the stomach 
is unsettled, and vomiting happens. Severe 
headache is frequently present. These symp- 
toms should cause the parent or care-taker to 
summon the physician at once. They are in- 
variably of sufficient importance to demand a 
medical examination. In severe cases the 
amount of poison introduced into the body 
may be so large as to overwhelm the nervous 
system. With these patients the temperature 
may not be raised, but may be lower than nor- 
mal, the pulse is weakened, and the patient is 
apathetic, restless, and evidently oppressed. 

The Eruptions from Infection or Contagion. 

While the infectious and contagious dis- 
eases are usually accompanied by eruptions, 
much experience is required to recognize the 
various eruptions and to decide which of these 
disorders is present. Amateur practitioners 
of medicine often come to grief in diagnostica- 
ting infectious or contagious diseases. Hence 
those who care for the child should not wait 
for an eruption to appear and should not take 
the responsibility of deciding, from the pres- 
ence or absence of eruption, whether the child 
is or is not sick. So soon as the general 



THE CHILD. 201 

symptoms described are present, the child's 
physician should be summoned. In excep- 
tional cases infection is so mild that the child 
is apparently not disturbed. Sooner or later 
some pronounced disturbance occurs in the 
general health which calls attention to the ex- 
isting condition. 

Isolation. 

When a child has been declared to have an 
infectious or contagious disease, it should be 
isolated. If several children be exposed at 
the same time, it does not follow that all will 
become infected. Hence the one proven to 
be infected should be immediately removed 
from the others. If possible, the upper rooms 
or floor of the house should be selected for 
this purpose, with a separate bath-room and 
with an abundant exposure to sunshine. If 
a trained nurse is not in attendance, some 
member of the family who can leave other 
duties must take charge of the case. The 
carpet and superfluous hangings and all un- 
necessary furniture should be removed from 
the selected room before the patient is taken 
to it. An open fire of some kind is especially 
desirable, excepting in very warm weather. 
Old linen should be selected for the case, and 
the toys and books used should be chosen 



202 MOTHER AND CHILD. 

with a view to their future destruction. The 
linen from such a case should not be washed 
with that of the other members of the family. 
Separate dishes and cooking-utensils should 
be employed. Communication with other per- 
sons should be by conversation from the upper 
to the lower stories, and if possible should not 
be in writing. This isolation must be main- 
tained until the patient is convalescent and 
has been thoroughly disinfected. 

General Nursing in Infectious Cases. 

Experience has shown that if a patient suf- 
fering from an infection be put at rest and be 
well fed and given needed stimulus, the cells 
of the body destroy the poisonous germs and 
the patient recovers. There is no reliable 
testimony that any form of medicine or drug 
can be swallowed in sufficient quantity to 
destroy infectious germs. Hence the feeding 
and general nursing of contagious diseases 
are most important. As various symptoms 
develop, the patient must be made as comfort- 
able as possible under the circumstances. 
The eruption often seen in these cases appar- 
ently results from the effort of nature to expel 
through the skin the poisonous bacteria. In 
many cases, after a few days' sharp illness, the 



THE CHILD. 203 

patient is much better and remains comfort- 
able during his convalescence. In severe 
cases the skin does not succeed in casting off 
the poison, the patient's nervous system be- 
comes profoundly depressed, and a fatal issue 
may result. The occurrence of excessive 
fever calls for sponging and bathing under the 
doctor's orders. Depression and prostration 
require stimulus. Excessive excitement or 
delirium requires constant and soothing care 
to avoid the exhaustion which often follows. 



CHAPTER XII. 

THE CONVEYANCE OF CONTAGION AND 
INFECTION. 

Contagion and infection are usually con- 
veyed by direct contact with a diseased per- 
son. While touch is the immediate cause of 
most contagion, polluted air may also convey 
disease germs, and articles used by persons 
having contagious diseases very frequently 
carry the disorder. Diseases differ in the 
manner in which the contagion is spread. 
Thus in scarlatina touch seems the usual and 



204 MOTHER AND CHILD. 

most important method of conveyance. In 
measles the contagion travels through the 
atmosphere, one case will practically infect an 
entire building, and it is often impossible to 
control the spread of the disease. At other 
times a child may associate for several days 
with its brother or sister ill with the measles 
without taking the disease. It is probable that 
diphtheria is conveyed by actual contact with 
the patient and also through polluted air. 
Fluids may convey the germs of diphtheria, 
scarlatina, typhoid, and other contagious dis- 
orders. While we may not have positive knowl- 
edge regarding the precise method of convey- 
ing contagion, we know sufficient to assist us 
in preventing contagion in many cases. One 
of the most remarkable diseases of modern 
times, influenza, or grippe, is conveyed by 
methods at present unknown. It has its origin 
in the filth centres of Asia, and is scattered 
throughout the world by pilgrims who visit 
shrines in that country. It is probably con- 
veyed by the atmosphere, and also by vessels, 
railway-cars, and other agents of transporta- 
tion. Success in protecting a household from 
infection by one of its members will depend 
somewhat upon the nature of the infection. 
In scarlatina, a sick child, if completely iso- 



THE CHILD. 205 

lated, may pass through the disease and no 
other member of the family be attacked. It 
seems possible to control the contagion of 
scarlatina successfully. 

Another factor in determining the spread of 
contagion lies in the time of illness at which 
exposure takes place. It has been thought 
that diseases accompanied by eruption are 
most contagious when the eruption is in full 
development. Others believe that the period 
of desquamation, when the skin is shedding 
its scales, is more apt to favor contagion. 

Disinfection of the Patient. 

It is of the utmost importance that every 
precaution be taken to protect others from 
contagious and infectious diseases. When 
convalesence is fully established, before break- 
ing up the isolation and quarantine, the patient 
must be subjected to as thorough a disinfec- 
tion as possible. In diseases accompanied by 
desquamation the use of a simple fat, with 
rubbing, followed by thorough washing with 
soap and warm water, will remove the debris 
from the skin which is often infectious. Anti- 
septic baths are prescribed by physicians when 
the patient is ready to leave the sick-room. 
Such are bichloride of mercury in solution of 



206 MOTHER AND CHILD. 

from 1-5000 to 1-10,000, carbolic acid in one 
per cent, solution, and lysol or creolin in the 
same solution. As these baths are made with 
poisonous substances, they should not be 
used without the doctor's direct order, and he 
should give specific directions as to the 
strength of the solution and the temperature 
employed. With children it is comparatively 
easy to cleanse the hair and scalp. As the hair 
frequently comes out in severe cases, it is 
better to cut it close and thoroughly wash and 
shampoo the scalp. An abundant growth of 
new hair will come in. It is important to 
remember that discharges from the body may 
be contagious for some time after the patient 
becomes convalescent. Thus, after measles 
and whooping-cough the mucous discharge 
from the throat and nose may convey con- 
tagion. The bacillus of typhoid infection is 
sometimes present in the urine and feces when 
the patient is apparently well. The germ of 
diphtheria has been found in the throat of 
patients in apparent good health. Every 
precaution should be taken to examine the 
discharges from the infected portion of the 
body before the patient is allowed to mingle 
freely with others. 



THE CHILD. 207 

Disinfection of Clothing', Bedding, Utensils, etc. 

The most efficient and simple method of 
disinfecting fabrics is by boiling. As this 
ruins many articles, a less destructive method 
has been found in fumigation. To be effectual, 
this must be thoroughly and carefully done 
and a disinfecting agent of known efficiency 
must be selected. If a trained nurse has not 
been employed to care for the patient, it is 
well to have the disinfection of the room and 
its contents done by the officials of a Board 
of Health or by some one procured from a 
hospital for this purpose. Disinfection by 
fumigation is done by sealing the room tightly, 
after unfolding and arranging the articles within 
it so that the fumigating vapor can pene- 
trate them and setting free in the room a 
disinfecting and germicidal vapor. Formerly 
the vapor of sulphur was universally employed. 
This was secured by burning sulphur in a tin 
or iron vessel over an alcohol lamp placed 
upon tin or iron or upon bricks in the centre 
of the room. A more efficient method con- 
sists in the use of the vapor of formaldehyde. 
This substance is prepared in tablets or pas- 
tiles, and may be burned with a lamp con- 
structed for the purpose as follows : The 



2o8 MOTHER AND CHILD. 

formaldehyde lamp is placed upon several 
bricks in the centre of a deep tin or iron 
vessel, like a large dish-pan. Into the pan is 
put sufficient water to come as near the lamp 
as possible. At the upper portion of the 
lamp there is a cup filled with formaldehyde 
pastiles, and a little alcohol is poured over 
them. The lamp at the bottom of the appa- 
ratus is filled with alcohol and its wicks 
trimmed and lighted. When the room and 
lamp are ready, a match is applied to the 
pastiles in the cup of the lamp. A vapor 
is instantly set free, and the person who is 
conducting the fumigation is obliged to leave 
the room as soon as possible. The door is 
tightly closed, calked with cotton, and paper 
pasted over the cracks. The lamp is allowed 
to burn out, consuming the pastiles within the 
cup. By experience the length of time neces- 
sary to consume the formaldehyde is ascer- 
tained, and at the end of this time the room is 
opened and aired. (Fig. 22.) 

Formaldehyde vapor does not injure colors 
in clothing or other objects, and is most effi- 
cient in destroying bacteria. It is intensely 
irritating to the eyes, nose, throat, and lungs ; 
and should leakage occur from the room, those 
in the house will experience great annoyance 



Fig. 22. 




-Formaldehyde lamp prepared for disinfecting- a room. The lamp stands upon 
bricks placed in a large pan containing several inches of water. 



THE CHILD. 209 

and irritation. To stop a room tightly, cracks 
should be plugged with cotton batting, the 
fireplace boarded up temporarily and paper 
pasted over the boards, key-holes plugged 
with cotton, cracks about the windows like- 
wise plugged, and paper pasted over cracks 
and apertures of every kind. Twenty-four 
hours is required for successful fumigation, 
after which time the doors and windows of the 
room should be left widely open for another 
twenty-four or forty-eight hours. After the 
room has been aired it should be thoroughly 
scrubbed with strong soap and hot water, and 
then with a carbolic acid or bichloride of mer- 
cury solution. In rooms which have been 
papered it is safest to remove the paper and 
to replace it by new. Fresh calcimine upon 
the ceiling is also an advantage. In rooms 
with painted walls and ceiling fumigation and 
thorough scrubbing are sufficient. 

While it is true that fumigation thoroughly 
cleanses toys, books, and other articles sub- 
jected to formaldehyde vapor, it is safer to 
destroy cheap articles rather than to run a 
possible risk of further infection. Articles 
which can be boiled should be subjected to 
this method of cleansing in addition to other 

precautions. 

14 



2io MOTHER AND CHILD. 



CHAPTER XIII. 

MEDICAL EMERGENCIES. 

Sudden illness sometimes arises which 
demands attention as soon as possible, often 
before a physician can be summoned. 

Poisoning. 

Poisonous substances are readily swallowed 
by children during the period of dentition. 
The irritation produced by the teeth leads the 
child to put every available object into its 
mouth. Poisons may be divided for this con- 
sideration into two classes, — those which act 
locally and those which act upon the body 
generally. A familiar example of a local poi- 
soning is lye. Strong alkalies or lye in solu- 
tion are used in cleaning kitchen sinks, drains, 
and woodwork, and in making soap. If a 
child drinks lye, little of it reaches the stomach. 
It irritates the throat so violently that the child 
usually ejects the poison before it is swallowed. 
Upon the throat the action of lye is most de- 
structive. A profound and active inflamma- 
tion is at once excited, and the tissues of the 



THE CHILD. 211 

child's throat are destroyed ; and should it 
survive the original poison, contraction or 
stricture of the oesophagus may finally bring 
about death through starvation and exhaus- 
tion. The treatment of poisoning by lye is 
to give the child salad-oil freely and to 
apply about the throat a compress wrung 
out of ice-water. Unfortunately, little can be 
done in these cases, as the poison acts very 
quickly. 

Antiseptics act in much the same manner 
as lye. Corrosive sublimate or bichloride of 
mercury is commonly put up in white tablets 
or lozenges which are not unlike candy. If a 
child should eat one of these, its death must 
result in a short time. The poison acts not 
only by irritating the intestinal canal violently, 
but also through its directly depressing effects 
upon the vital organs of the body. Carbolic 
acid in solution acts locally and generally. In 
strong solutions it burns the tissues, and when 
absorbed, paralyzes the vital organs. Nitrate 
of silver solution is an antiseptic and counter- 
irritant which is occasionally within the reach 
of children. Its action is somewhat similar to 
that of carbolic acid. In the treatment of 
poisoning by antiseptics which have been 
swallowed, the child should be made to vomit 



212 MOTHER AND CHILD. 

as soon as possible. Copious draughts of 
warm salt and water or of warm water with a 
little mustard can be taken. The child should 
be held with the head downward and the 
fingers carried downward and backward into 
the throat to irritate the fauces. Following 
this as much olive oil as possible should be 
swallowed, or, if time permits its preparation, 
white-of-egg water should be given very 
freely. Should symptoms of excessive pros- 
tration develop, two teaspoonfuls of whiskey 
in two ounces of warm water may be injected 
into the rectum. 

Other poisons which act locally as well as 
generally are tincture of iodine and various 
liniments. Iodine is detected by the stain 
upon the mouth, and most liniments have a 
decided and peculiar odor. The treatment of 
poisoning from these substances is that already 
given. 

Poisons which do not act locally after absorp- 
tion and which are commonly within the reach 
of children are opium in some form, strychnia, 
and prescriptions containing mercury or bella- 
donna. If there is the slightest suspicion, upon 
a child becoming ill, that it has swallowed a 
medicine, it can do no harm to cause the 
child to vomit. The matter ejected from the 



THE CHILD. 213 

stomach in these cases should invariably be 
saved for inspection by the physician. When 
opium is absorbed it causes drowsiness, very 
small pupils, and very slow breathing. The 
child may be kept awake until the doctor 
arrives by giving it strong coffee. In strychnia 
poisoning the child's muscles become rigid and 
convulsions follow. A hot bath may be given 
to relax the muscles and nerves until the doctor 
arrives. When medicines containing mercury 
are swallowed by children, the stomach is usu- 
ally irritated and the child generally vomits. 
If not, vomiting should be induced, and then 
oil should be given. Belladonna in medi- 
cine produces redness of the face and skin, 
dryness of the throat, widely dilated pupils, 
and often a noisy and active delirium. Until 
the arrival of the physician the child should 
be given an abundance of water and whiskey 
or brandy, in small doses proportionate to its 
age. 

Parents and others are often greatly 
alarmed when children swallow medicines 
whose strength is not known by the patient 
or solutions of unknown composition. There 
can be no harm in causing the child to empty 
its stomach under such circumstances ; and 
the physician should be informed of the acci- 



214 MOTHER AND CHILD. 

dent, when, by reference to his notes, he can 
ascertain what has been taken, and treat the 
child accordingly. 

Prevention of Poisoning. 

All medicines and antiseptics used during 
an illness should be disposed of after recovery. 
Boracic acid, in solution or powdered, is the 
best antiseptic for use among children, as it 
is not, except in large quantities, poisonous. 
Only this should be kept in a nursery. It is 
the duty of the trained nurse in attendance 
upon a case of illness to see that no poisonous 
substances are left available to children and 
ignorant persons. During an illness in which 
such substances must be used the poison 
should be kept in colored or roughened bot- 
tles, plainly labeled, and when not in use they 
should be placed in a closet or medicine-case 
out of the reach of children. It is safest to 
keep them under lock and key. Especial care 
must be taken in giving doses to children 
during the night. No poisonous substance 
should be left in a sick-room during the night, 
and only those medicines likely to be needed 
or substances which are not poisonous should 
be easily available. Nothing should be given 
to a child in a dark room until it has been 



THE CHILD. 215 

carefully inspected. A mother or care-taker 
should procure a light and examine the medi- 
cine thoroughly before administering it. Phy- 
sicians will co-operate with mothers in pre- 
venting mistakes by having the prescriptions 
written upon the bottles and explaining to the 
mother the probable effect or composition of 
each prescription. Patented medicines and 
preparations are not thoroughly safe, for the 
reason that their formulas are not generally 
known, and it therefore cannot be learned 
exactly what each contains. If a large dose 
be taken, the results likely to follow are 
uncertain. 

Acids and Alkalies. 

A simple rule of chemistry will guide us in 
cases where a child swallows a strong acid. 
The most available bland alkaline substance 
should be given. Baking-soda and water, 
lime-water, rochelle salts, bicarbonate of soda, 
or, in emergencies, plaster scraped from a wall 
and dissolved in water may be used. If alka- 
lies are swallowed, dilute acids, such as lemon- 
juice or vinegar and water, should be given. 
In either case the free administration of oil is 
indicated. 



216 MOTHER AND CHILD. 

Convulsions. 

The sensitive nervous system of a child is 
very easily thrown into convulsions. The 
child closes its mouth tightly, moves its limbs 
violently, becomes blue in the face, and sinks 
into a partially unconscious state until the 
succeeding convulsion. Convulsions may be 
caused by any condition which severely irri- 
tates the nervous system. Acute disturbance 
of the intestines, irritation about the genital 
organs, or about the mouth or jaws, mental 
and nervous shocks, exposure to severe heat 
or cold may all cause convulsions. Medical 
aid must be summoned immediately. If the 
weather be cool or cold, the child should be 
placed in a hot-water bath (containing ground 
mustard in the proportion of a handful to a 
child's bath-tub of water) until the physician 
arrives. The surface of the body should be 
gently rubbed until it becomes bright red. A 
cloth wrung out of cold water should be 
placed upon the forehead of the child. A soft 
handkerchief, folded into a plug as large as 
the thumb, should be placed in the corner of 
the mouth in order to keep it open and to pre- 
vent the child, if it has teeth, from biting its 
tongue. It can do no harm to empty the 



THE CHILD. 217 

child's bowels in such a case by an injection 
into the rectum of a pint of warm castile soap- 
suds. Further treatment must come from the 
physician, as judgment and skill are necessary 
in detecting the cause of the convulsions. If 
there is reason to suspect that the child has 
swallowed an irritating substance or infected 
food, it may be made to vomit with advantage. 

Heat-Stroke. 

Sunstroke is scarcely the proper term to 
apply to heat-prostration in young children, as 
they are rarely allowed to expose themselves 
directly to the rays of the sun. Young chil- 
dren are usually kept quiet during excessive 
heat, and therefore they do not have the acute 
and pronounced forms of heat-stroke seen in 
working-people. A period of excessive heat 
accounts naturally for the occurrence of heat- 
stroke. The child becomes listless, apathetic, 
refuses nourishment, moans almost constantly, 
and gradually sinks into a stupid, unconscious 
condition. The surface of the body may be 
deceptively cool while the internal temperature 
is raised. So far as atmospheric conditions 
are concerned, excessive dampness is almost 
as dangerous as a temperature unusually high. 

The care of a child suffering from heat- 



218 MOTHER AND CHILD. 

stroke is very similar to that necessary for an 
adult. The child's clothing should consist 
only of a thin flannel band placed over the 
abdomen and a diaper. It should be carried 
to the coolest available spot and given the best 
air possible. Until the physician's arrival the 
child should be sponged with cool water con- 
taining alcohol in the proportion of a table- 
spoonful to the quart. A cloth wrung out of 
cool water should be placed upon the forehead. 
It is well to empty the child's bowels by an 
injection of cold water and to give ice- water 
in teaspoonful doses. Small doses of brandy, 
ten drops to a child six months old, may be 
given in ice-water every two or three hours. 
Albumin water may be given for nourishment. 
Under no circumstances should milk be allowed 
to a child suffering from heat-prostration. 

If medical advice cannot be procured, the 
child's life may be saved by taking it at once 
into better air. The seashore or high land in 
the country or in the mountains should be 
sought as soon as possible. Very sick chil- 
dren, if given proper attention, are frequently 

rescued. 

Nose-Bleed. 

Children are often much annoyed by the oc- 
currence of nose-bleed. This is frequently an 



THE CHILD. 219 

indication that diseased tissue which should be 
removed is present in the nostril. A child 
who suffers from this condition should be given 
a thorough examination to determine this 
point. When severe nose-bleed occurs, the 
child should be laid down with its head and 
shoulders considerably raised. Iced water may 
be sprayed or injected into the nostrils, and 
cloths wrung out of iced water, or ice wrapped 
in cloths, may be applied over the nose. The 
child should be encouraged to avoid blowing 
the nose as much as possible, and should be 
urged to spit out blood which drops through 
the posterior part of the nose into the mouth. 
If the child swallows blood from the nose, a 
dangerous quantity may be lost before the 
fact is detected. The child's physician should 
be summoned if the bleeding becomes pro- 
nounced, for it may be necessary to check it 
by a simple surgical procedure. 

Prolapse of the Intestine. 

In children who suffer from constipation or 
who are weakened from prolonged disease it 
is not uncommon to see prolapse of the lower 
bowel. This is seldom dangerous, but it may 
annoy the mother or care-taker, and should 
receive attention. The child should be placed 



220 MOTHER AND CHILD. 

upon its back, with its hips raised and the pro- 
lapsed intestine thoroughly anointed with vas- 
eline or cold cream. Gentle pressure should 
be made with the thumb upon the bowel next 
the skin, and it should be gradually pressed 
backward within the body. The finger should 
then be thoroughly oiled and introduced into 
the bowel, carrying the intestine up beyond 
the internal ring or sphincter muscle. Such 
an accident may usually be prevented by in- 
jecting warmed olive oil for a bowel move- 
ment and by urging the child not to strain 
when the movement is desired. 



CHAPTER XIV. 

SURGICAL EMERGENCIES. 

Surgical emergencies demand prompt pro- 
fessional care, for the reason that a child bears 
loss of blood badly and is easily thrown into 
shock. Much can be done to mitigate suffer- 
ing and to lessen danger by those having 
charge of children, and hence a knowledge of 
simple methods of treatment is necessary. 



THE CHILD. 221 

Cuts. 

Children are very apt to cut themselves 
with edged tools, broken glass, etc. A finger 
is often partially severed by a knife or a 
hatchet. Free bleeding occurs instantly, and 
when the child is seen a clot of more or less 
size surrounds the cut. Until the physician 
arrives there are three indications : First, to 
immediately remove by a stream of water all 
dirt, pieces of clothing, or any other foreign 
matter which may have gained access to the 
cut ; second, to place a pad of soft clean linen 
over the cut ; and, third, beginning at the tip of 
the finger or limb, to wrap up the parts firmly 
over the compress with a bandage. An old 
sheet, torn into strips two or three inches wide, 
makes an excellent bandage. For a com- 
press a perfectly clean handkerchief is best. 
The child should be made to lie down and the 
limb elevated upon a pillow. It is a natural 
inclination to give a child stimulants freely. 
If alcohol be given in considerable quantity, 
the tendency to hemorrhage is increased. If 
the child loses much blood and is pallid, 
one-half a teaspoonful of brandy may be 
given in hot water. One-half a pint of warm 
water in which is dissolved one-half a tea- 



222 MOTHER AND CHILD. 

spoonful of table-salt may be injected slowly 
and gently as high into the bowel as pos- 
sible, and allowed to remain for absorption. 
Should blood soak through the compress, the 
bandage must not be removed, but another 
compress and bandage should be applied over 
the first. Medical aid must be obtained as 
soon as possible, and there should be pre- 
pared for the physician an abundant supply of 
hot water and clean old linen. 

Where a finger or toe is severed by a cut, 
the parts should be cleansed with clean water 
and the severed portion put back firmly against 
the cut surface and retained by a compress or 

bandage. 

Burns. 

Among the most common accidents to chil- 
dren are those caused by fire. Especial pre- 
caution should be taken in guarding children 
against fires of all sorts. A substantial wire 
guard should be kept before open fireplaces 
and grates, and a child should not be allowed 
in a kitchen where it can get access to a range. 
Safety-matches only should be used in nur- 
series, and burned matches should either be 
disposed of in the open fire or placed in china 
receptacles out of the reach of children. Gas- 
fixtures should not be within reach of a child, 



THE CHILD. 223 

even though it get upon a chair. Especial 
care should be taken in nurseries that window- 
curtains are so placed that they can by no 
accident blow into a burning gas-jet. 

It may not be amiss to give the old advice, 
that should a child's clothing take fire, it 
can best be put out by stripping its clothing 
rapidly off and wrapping the child in a blanket. 
If the outer clothing only is burning, it is best 
to wrap the child immediately in a blanket, 
without trying to strip the clothing. When 
children burn their fingers, as they most fre- 
quently do, a cold solution of bicarbonate of 
soda or a paste made of bicarbonate of soda 
and cold water and spread upon soft linen 
may be applied at once. This diminishes pain 
and heat in the part and is an excellent first 
dressing. In fact this dressing may be applied 
over any portion of the body with great com- 
fort and advantage to the patient. In ex- 
tensive burns considerable shock occurs, and 
the child should receive moderate stimula- 
tion with brandy or whiskey well diluted. If 
medical advice cannot be procured for some 
time, and the skin of the burned part has 
been destroyed and matter begins to form, 
it is sometimes necessary to use oiled dress- 
ings. A dressing of sweet oil and lime-water 



224 MOTHER AND CHILD. 

answers a useful purpose in such cases. 
Every effort should be made to put a burned 
child in the doctor's care as soon as possible, 
as a scar may often be lessened by prompt 
and skilful attention to the healing of the burn. 
If the child be burned in the face, most assidu- 
ous care is necessary to lessen a severe scar, 
and trained nurses are indispensable if the 
child is to be kept at home. The period of 
greatest pain following a burn comes a short 
time after the accident, when the child's system 
reacts from the shock. Fortunately, medical 
aid can always be obtained in time to pre- 
vent the suffering which would occur at this 
period. 

The recovery from a severe burn is very 
slow and tedious. Such patients should be 
placed in hospitals, if abundant trained nursing 
and proper facilities for the care of the child 
are not at hand. Such cases require very fre- 
quent applications, and the soiled dressings 
should be burned so soon as removed. In 
cases where the eyes are burned or irritated 
by fire the child should be kept in a darkened 
room and compresses of iced water placed 
upon the lids and brow. Iced water may be 
dropped into the eyes as the child desires. 
Such treatment must not be continued except 



THE CHILD. 225 

during the brief interval before the doctor 
arrives. 

Burns from acids, strong lye, or other chem- 
icals should be treated in the same manner as 
burns from fire. In burns from acids the soda 
application at once destroys the effect of the 
acid and stops the spread of the burn. In 
burns from alkalies the use of oil with lime- 
water is especially valuable. 

Falls, Fractures, and Sprains. 

Children by falling are continually illustra- 
ting the fact that the head is heavier than the 
rest of the body in early childhood. Their 
remarkable escapes from serious injury are 
due, in part, to the soft condition of their 
bones and to the fact that they are seldom left 
unguarded in exposed positions. If a fall is 
followed by partial unconsciousness, and the 
child is pale, it should be put to bed, most of 
its clothing removed, and its head raised 
slightly upon a very low pillow. The room 
should be somewhat darkened and the child's 
physician summoned at once. The occur- 
rence of bleeding from the mouth, nose, or 
ears after a severe fall should invariably be 
reported to the physician. 

Young children rarely have complete frac- 



226 MOTHER AND CHILD. 

tures, but the bones are usually bent, as a 
twig of a tree may be bent and its fibres 
broken within the bark. Sprains are very 
common among children, and are often neg- 
lected, because they are not fractures. 
When a child's limb is injured by fracture or 
sprain it should be put to bed at once, its 
clothing removed, and the injured limb placed 
in a proper position. If it be the lower ex- 
tremity, the limb should be extended, resting 
upon the heel, and the injured part placed in 
what is termed a blanket splint. (Fig. 23.) 
This is made by folding a shawl wide enough 
to extend from six to eight inches on each 
side of the affected joint. The shawl is then 
rolled from each of its two ends. Two rolls 
are thus formed, which are turned over, and 
the injured limb allowed to rest between them. 
Several pieces of loose bandage are then tied 
about the limb, holding the rolls close against 
the injured portion. In this way the limb is 
immobilized by a very soft and comfortable 
dressing sufficiently to prevent serious injury. 
If the skin be broken, and a raw and bleeding 
surface is present, a piece of perfectly clean 
soft linen should be placed against the raw 
surface and the blanket splint applied over 
that. 





3 




THE CHILD. 227 

Setting an Injured Limb. 

The effort is sometimes made to reduce or 
set a dislocated or broken limb. Such efforts 
by untrained persons are dangerous, and 
should be avoided. In injuries to the lower 
extremities the limb should be placed straight, 
if the patient can bear it, resting upon the heel, 
and kept quiet by such a splint as the blanket. 
If the effort to place the limb straight causes 
pain, the patient may be allowed to keep the 
limb in any position which is most comfortable 
until further assistance can be procured. 

Foreign Bodies in the Air- Passages. 

It is not a rare occurrence for children to 
get into their throats foreign bodies which 
expose them to the danger of suffocation. 
Caution should be taken that children be not 
allowed access to bodies which contain par- 
ticles that might be removed and drawn into 
the throat. The writer recalls the case of a 
child who was choked to death by a piece of 
cork which became separated from a large 
cork with which it was playing. Occasionally 
a child is choked by a piece of bread crust, or 
meat, or other firm substance which is drawn 
into the windpipe. 



228 MOTHER AND CHILD. 

When symptoms of choking appear, do not 
put anything into the child's mouth at first. 
The natural inclination is to thrust the finger 
into the mouth to bring out whatever may be 
there. This is the worst thing that can be 
done, as it almost inevitably forces the foreign 
body further down. Instead of doing this, the 
child should be grasped firmly by the thighs 
and held head downward. One hand should 
be placed upon the forehead and the head 
very gently moved backward towards the 
spinal column. A few light strokes upon the 
back between the shoulders will usually cause 
the foreign body to be immediately expelled. 
If this does not succeed, nothing further can 
be done except to await the arrival of a 
physician. 

Foreign Bodies in the Eye. 

A foreign body in the eye will nearly always 
be removed by the slight movements of the 
eyeball itself. The injured eye should be im- 
mediately closed and covered by a light pad 
of clean cotton and a bandage or handker- 
chief. This should remain for several hours, 
when it may be cautiously removed. The 
child will then soon know whether or not the 
foreign body is present. 



THE CHILD. 229 

As soon as possible a physician should be 
summoned, or the child taken at once to a 
physician's office. If this cannot be done, the 
lid may be turned and the foreign body brushed 
away by the finger covered with a very soft 
clean handkerchief. To turn the lid, the child's 
head must be held firmly by an assistant. The 
hands should be thoroughly washed, and a 
small, smooth, round object, like a pocket 
pencil, chosen. The lid to be turned should 
be grasped firmly at about its centre, as 
near the edge as possible. The pencil or rod 
should be laid upon the middle of the lid and 
the lower edge turned backward over the rod. 
The inner surface of the lid is thus visible, 
when the foreign body can usually be seen 
and removed by the finger. 

The eye is peculiarly liable to some kinds 
of septic infection, and blindness may result 
in these cases. Should a child have a sore 
which forms matter, especial precaution is 
necessary that none of the matter gains access 
to the eyes. In some instances children are 
born with infected eyes, and acute inflamma- 
tion rapidly develops. 

The treatment of these cases consists essen- 
tially in cleansing the eyes thoroughly with a 
mild antiseptic solution. This must be pre- 



230 MOTHER AND CHILD. 

scribed by the physician in attendance, also 
the method by which it is to be employed. 
In most cases washing the eye by a stream of 
fluid or by irrigation is most desirable. Many 
physicians prefer to have this done by drop- 
ping the antiseptic solution into the eyes with 
a medicine-dropper, the lids being gently dried 
with clean aseptic cotton. In other cases irri- 
gation is practised by placing the solution in a 
fountain syringe, putting into the tip of the 
syringe a medicine-dropper to serve as a noz- 
zle, and so directing the stream that it shall 
not affect the sound eye. To accomplish this 
the nurse sits with her lap protected by a rubber 
apron and with a jar or basin at her feet into 
which the fluid may run. (Fig. 24.) The sound 
eye is covered by cotton and a bandage, and 
the child is turned upon its side with the in- 
fected eye lower than the other. The stream 
of fluid is then allowed to run from the inner 
angle of the affected eye through the lids, 
passing upon the outer side into the receptacle 
beneath. In this manner the eye is cleansed 
thoroughly with the least possible injury and 
disturbance. When the eye has been thor- 
oughly cleaned, the lids are very gently dried 
with aseptic cotton. Caution must be exer- 
cised that the fluid used in irrigation does not 



Fig. 24. 




Douching an inflamed eye with antiseptic solution. The affected eye is the 

left or lower one. 



THE CHILD. 231 

spatter into the eye of the person who gives 
the irrigation, as infection and inflammation 
may result. 

The matter which forms in the eyes in these 
cases is violently infectious and contagious 
both for children and adults. In countries 
where no precautions are taken to prevent 
the spread of inflammation of the eyes many 
cases of blindness result from this cause. 
Hence the necessity for burning all pieces of 
cotton or handkerchiefs used in cleansing the 
eyes, for thoroughly washing the hands after 
the eyes have been irrigated, and for cleansing 
with an antiseptic solution all rubber cloths or 
utensils employed in such cases. 

In addition to the disinfection of the eye, 
physicians often prescribe cold applications to 
subdue inflammation. A piece of ice should 
be placed in a convenient basin or tub, and 
upon this spread small bits of clean old linen. 
These are put upon the lids and changed con- 
tinually night and day. So virulent is the in- 
fection in many cases that nothing but the 
most active and continuous treatment avails 
to check it. Blindness is such a frightful 
calamity that every effort should be made to 
carry out the treatment prescribed in the most 
thorough and efficient manner. 



232 MOTHER AND CHILD. 

Foreign Bodies in the Ear. 

Insects often gain access to children's ears, 
and buttons and other small objects are some- 
times crowded into their ears during play. 
The motions of the insect usually cause great 
irritation and severe pain. A solid body, like 
a button or a grape-seed, may not at first 
cause much suffering, but as it becomes soft- 
ened and begins to swell it will occasion acute 
distress. 

It is often difficult to remove a foreign body 
from the ear. Hence no attempt should be 
made with pieces of wire or other improvised 
instruments, but the physician's aid should be 
summoned at once. If the child is suffering 
great pain, hot water at a temperature of from 
ioo° to no° F. may be dropped into the ear 
by a medicine-dropper and a hot-water bag 
laid against the side of the head. If the in- 
truder is an insect, it will soon die, and when 
its motions cease the child's suffering will be 
somewhat lessened. If possible, the water 
dropped into the ear should have been previ- 
ously boiled, so as to avoid the introduction 
of impurities and germs from without. 



THE CHILD. 233 

Earache. 

This distressing symptom may result from 
one of several causes and may occasion great 
suffering. It often comes on at night, some- 
times after exposure to cold, and frequently 
without appreciable cause. The pain is usually 
referred to the ear only, occasionally radiating 
into the side of the neck and to the jaws or 
along the side of the head. No one method 
of treatment can meet all indications. Until a 
physician can make an examination, it is safe 
to use external heat in the form of a hot-water 
bottle ; and if there is reason to think that 
possibly an insect has gained access to the 
ear, sterile hot water may be dropped into it 
as already described. We cannot emphasize 
too strongly the fact that it is exceedingly dan- 
gerous to put objects into the ear or to drop 
into it unknown substances, as infection may 
be conveyed and a very serious inflammation 
result. The physician must take the respon- 
sibility of selecting the substance to put within 
the ear and of directing its method of appli- 
cation. 

Foreign Bodies in the Nose. 

Children may also introduce seeds, pebbles, 
or other foreign bodies within the nostrils. 



234 MOTHER AND CHILD. 

They rarely cause so much suffering as those 
within the ear or the eye ; but if they remain for 
some time they cause inflammation, with a dis- 
charge of matter and mucus from the nostril. 
When this accident happens, the other nostril 
should be closed by the finger and the child 
directed to blow through the impeded side. 
Very frequently the foreign body is thereby 
expelled. If the child's head be held down as 
it blows, a better result is often obtained. 
Unless the foreign body can be distinctly seen, 
it is better not to introduce pieces of wire or 
other substances in the endeavor to bring it 
away. If the body can be seen, a pair of blunt- 
pointed pincers or tweezers, with slender 
blades, should be thoroughly washed with soap 
and hot water and then cautiously introduced 
for its removal. 

Foreign Bodies Swallowed by Accident. 

Pins, pieces of rubber, buttons, and other 
foreign substances may be swallowed by chil- 
dren. Unless experience had demonstrated 
the fact it would seem incredible that an object 
as large as a piece of erasing rubber could 
readily be swallowed by a child. This acci- 
dent happened in the writer's experience. 
The child was laughing, its mouth being wide 



THE CHILD. 235 

open, and another person snapped the rubber 
directly into its throat. Before the child was 
aware of what had happened, the rubber had 
been swallowed. 

The natural inclination in these cases is to 
give a purgative as soon as possible. No 
greater mistake can be made. The foreign 
body causes danger by its liability to become 
fixed in the bowel and thus set up inflamma- 
tion and perforation. A purgative removes 
the other contents of the bowel ; and while it 
may move the foreign body along the intes- 
tine, it rarely secures its expulsion. 

To remove a foreign body which has been 
swallowed, vomiting should not be induced, 
but the child's diet should be carefully limited, 
using only such articles as will fill the intes- 
tine completely with a soft and unirritating 
mass. Such substances are bread and milk 
and mashed potato. The child's diet for from 
twenty-four to forty-eight hours should be 
limited as nearly as possible to these articles, 
and of these the child may have as much as it 
desires. At the end of this time a large dose 
of castor oil or sweet oil should be given, and 
repeated in a reasonable time. By this treat- 
ment the foreign body will usually be expelled 
from the intestine without injury to the patient. 



236 MOTHER AND CHILD. 

Foreign Bodies in the Bowel or Bladder. 

Children occasionally introduce foreign 
bodies into the bowel or bladder which may 
give rise to inflammation with serious results. 
Medical aid is indispensable in such cases, as 
the effort to remove such a body requires skill 
and experience. Its presence may be inferred 
when the child has difficulty in emptying the 
bladder, followed by pain and irritation, there 
being no obstruction at the opening of the 
urinary channel which prevents the passage 
of urine. When the foreign body is in the 
bowel, diarrhoea is apt to occur, accompanied 
or followed by the discharge of mucus and 
blood. 



CHAPTER XV. 

EXTERNAL APPLICATIONS. 

Many of the disorders of children are suc- 
cessfully treated largely by external applica- 
cations. It is important that these should be 
understood and the child's physical peculiari- 
ties remembered in carrying out this method 
of treatment. 



THE CHILD. 237 

The Application of Cold. 

In severe fever and in diseases of the throat 
and lungs physicians often prescribe cold ap- 
plications. The temperature of the water 
from which the application is to be made will 
be definitely stated by the physician. If the 
phrase "a cool compress" be used, it may be 
taken to mean water of the same temperature 
as that of the room occupied by the patient. 
Soft flannel should be selected for these ap- 
plications and wide enough to cover amply 
the part of the body under treatment. A 
stimulating application is usually combined 
with cold, and this the physician must per- 
sonally select and prescribe. The compress 
is wrung out of water in such a manner that, 
while it is not dry, it does not contain a great 
amount of moisture. Experience alone can 
determine the degree of saturation required. 
The flannel may be sprinkled with the stimu- 
lating remedy, or the latter may be added to 
a definite quantity of water. Thus, a table- 
spoonful of spirits of turpentine may be added 
to one quart of water. This compress is 
wrapped about the trunk of the body, across 
the chest or abdomen, or around the limb to 
be treated, and over this is placed one thick- 



238 MOTHER AND CHILD. 

ness of thin, dry flannel. The compress 
should be allowed to dry upon the body of 
the patient and be removed when dry. 

In cases of severe disease with high temper- 
ature, the physician may direct that an ice-bag 
be applied over a compress. It is often more 
comfortable to the patient if the ice for such 
an application be broken into small pieces, or 
even pounded, before being put into the ice- 
bag. An ice-poultice is sometimes prepared 
by mixing ice with bran and quilting it into 
cheese-cloth. Cold may be continuously ap- 
plied by fitting upon the diseased part a coil 
of rubber tubing sewed on to felt or spongio- 
piline. Through this coil of tubing iced water 
may be kept constantly circulating by siphon- 
age. Skull-caps for application to the cranium 
and sets of tubing to use upon the limbs and 
abdomen are frequently employed. This 
method is most efficient. In using cold ap- 
plications, the general condition of the child 
must be watched, and should prostration de- 
velop, the applications should be abandoned. 
Stimulants are usually given in conjunction 
with cold applications in cases where this treat- 
ment is employed. 



THE CHILD. 239 

The Application of Heat. 

In some cases the application of heat is of 
great value. Flannel may be used as in the 
cold applications, the temperature of the water 
being prescribed by the physician in charge. 
A temperature of from 90 ° to ioo° F. is re- 
quired in order to produce any effect by heat. 
A higher temperature may be added in some 
cases. A fomentation is a hot application in 
which the effort is made to retain and continue 
the heat as long as possible. For this purpose 
the flannel is applied as before, and over it is 
placed oiled silk or sheet rubber. The action 
of such an application is often more powerful 
than when the impervious material is not used, 
so caution must be exercised that such appli- 
cations do not remain too long upon the skin. 

The most convenient and usual method of 
applying heat is by hot-water bags. These 
can be obtained in various shapes and sizes, 
fitted for application to all parts of the body. 
Especial care must be exercised that bags 
used for either hot or cold water should not 
leak. Frequently the stoppers in these bags 
are not perfectly tight, and the patient is 
thereby greatly annoyed by a slight but con- 
stant leakage. 



2 4 o MOTHER AND CHILD. 

Heat was formerly applied most frequently 
in the form' of poultices. These were com- 
posed of some harmless mixture, such as 
bread and milk, flaxseed, bran, or other ma- 
terials which retained the heat for a consider- 
able time. Counter-irritation was often made 
by poultices, and the mustard-poultice was 
especially selected for this purpose. In 
making these for children the mustard must 
be greatly diluted by mixing it with flour or 
other material.* 

For external applications turpentine stupes 
are most often employed. While irritation of 
the skin rarely occurs, it may happen to such 
an extent as to make the child very uncom- 

* The following method for making a mustard -poultice 
whose action is mild and unirritating is ascribed to Dr. 
James Tyson, of Philadelphia. It is known in the hos- 
pitals as the Tyson plaster : 

Kitchen mustard, i teaspoonful ; 
Flour, 3 teaspoonfuls ; 

White of one egg, and molasses sufficient to make a 
smooth paste. 

If molasses is not available, glycerine may be used. 

This mixture is unsuccessful unless stirred very thor- 
oughly for at least fifteen minutes. It is then a smooth 
paste, much milder in action than so-called mustard 
leaves, and in most cases may be left upon the patient 
longer than a mustard leaf. 



Fig. 25. 





Eaby in bath. Showing most convenient arrangement of soap, powder, cotton 
sponges, brush, and all necessaries for the toilet. Screen behind nurse to keep 
off any possible draught. Screen also useful for hanging long petticoats, dress, etc. 



THE CHILD. 241 

fortable, and occasionally to produce consider- 
able injury. A definite proportion of turpen- 
tine should be mixed with the water, and the 
physician's advice should be asked regarding 
the strength of the application. It must also 
be remembered that a hot-water bottle placed 
against any portion of the body covered by 
wet flannel very easily blisters and burns. 
Only dry flannel should be placed between the 
skin and a hot-water bottle. Older methods 
of treatment by counter-irritation have very 
largely disappeared with our increased knowl- 
edge of better and more modern ways. 

Baths. 

The ordinary bath of the young child is a 
thorough cleansing with soap and tepid or 
warm water. To avoid the risk of contamina- 
tion, the head should be cleansed by a wash- 
cloth or sponge separate from that employed 
to cleanse the body. Wash-cloths used in 
sponging or bathing should be repeatedly 
boiled, and sponges should be thoroughly 
dried in the sun and frequently renewed. 
The plainest and purest sorts of soap, devoid 
of pronounced perfume, should be selected. 
The child should never be exposed to a draft 

while bathing (Fig. 25) ; and if the weather be 

16 



242 



MOTHER AND CHILD. 



cool and the room not thoroughly warm, the 
child should not be put in a tub, but should be 
sponged instead. A bathing-apron is of great 
value while bathing young children. This 
consists of flannel sufficiently long to cover 
the lap of the mother or care-taker. While 
being bathed the child is placed upon the 
under layer of the bathing-apron, and is kept 

Fig. 26. 




Rubber bath-tub. 



covered with the upper portion during the 
bath. The limbs are sponged rapidly and 
gently, and thus the body receives a thorough 
and brisk going over. In giving a child a 
tub-bath care must be taken that the child 
does not slip from the grasp of the care-taker 
and injure itself against the tub. The rubber 
bath-tub is especially soft and useful for young 
children. (Fig. 26.) 



THE CHILD. 243 

Baths for Medicinal Purposes. 

The cold bath is sometimes prescribed to 
reduce temperature. The degree of cold to 
be administered must be determined by the 
physician only, as it is a matter of grave 
importance. The child should be thoroughly 
rubbed while in the bath, and given a stimu- 
lant as soon as it is removed. It must be 
dried with a rough towel, or with flannel, 
accompanied by vigorous friction. 

The hot bath is sometimes given in cases 
of infection, when it is desired to produce an 
eruption. It is also given in cases of severe 
congestion in the internal organs, when it is 
necessary to bring blood actively to the sur- 
face of the body. The temperature of the 
water should be prescribed by the physician. 
Water which feels hot to the mother's elbow 
or which tastes hot will be hot to the body of 
a child. A small handful of ground mustard 
to the ordinary bath will much increase its 
counter-irritant properties. When giving a 
hot bath the room must be thoroughly warm, 
and care must be taken that the child is not 
exposed to drafts while in the bath or after- 
wards. If the child is much oppressed by 
disease, a cloth wrung out of cool water 



244 MOTHER AND CHILD. 

should be placed upon its head while in the 
bath. 

Medicated baths for children may contain 
sea-salt, or common salt, or bran, or bicar- 
bonate of sodium, or an antiseptic substance 
for disinfection. The medicine employed and 
the preparation of the bath must be as 
ordered by the physician in charge. In using 
medicated baths, care must be taken that the 
fluid does not enter the child's mouth, nose, 

or eyes. 

Counter-Irritation. 

By counter-irritation we mean the applica- 
tion of some stimulating substance to the out- 
side of the body to affect the condition of the 
nerves and blood in the deeper organs. Evi- 
dently counter-irritation, if carried to extreme, 
would injure the external portion of the body 
by destroying the skin. Dangerous and even 
fatal burns have followed the improper use of 
counter-irritation. The substances most com- 
monly used for this purpose are tincture of 
iodine, camphor in the form of camphorated 
oil, turpentine, and sweet oil, liniments of 
various sorts, and mustard. Tincture of iodine 
may be painted over a painful joint or any 
portion of the body which is exceedingly sensi- 
tive ; it leaves a dark, yellowish-brown stain. 



THE CHILD. 245 

If repeated applications be made, the skin, 
which at first hardens, will gradually die and 
come off. For young children the iodine is 
often diluted before application, to avoid ex- 
cessive irritation. When swallowed, tincture 
of iodine is an irritant poison, and hence 
caution must be taken with children in using 
it. Turpentine and sweet oil are used to rub 
the chest of a child suffering from a severe 
cold or bronchitis. One part of spirits of tur- 
pentine to five parts of sweet oil may safely 
be employed with robust children. 

Should a too strong counter-irritant be used, 
blisters will form, and the upper layer of the 
skin will gradually separate and die. If the 
irritation is extreme, an ulcer or sore will de- 
velop ; and if the irritant is absorbed, the 
child's kidneys or intestines may be affected. 
Should such an accident happen, the counter- 
irritation must be at once removed and warm 
fomentations be applied until the doctor can 
suggest further treatment. 

Injections. 

By injections are commonly meant fluids 
inserted into the bowel to cause a motion of 
that organ. Such are castile soapsuds and 
various preparations containing oil or medi- 



246 MOTHER AND CHILD. 

cines. The following preparations have been 
found useful, and are recommended, subject to 
the approval of the child's physician : 

( i ) Castor oil or olive oil, i ounce ; 

Castile soapsuds (temperature ioo° F.), i quart. 

Mix together as thoroughly as possible ; add one dram 
of spirits of turpentine, thoroughly beaten up with the 
yolk of one raw egg. 

(2) Magnesium sulphate, 2 ounces; 
Glycerin, 2 ounces; 

Spirits of turpentine, ^ ounce ; 
Castile soapsuds, 1 quart. 

(3) Powdered ox-gall, *4 ounce; 
Olive oil, 1 ounce ; 

Water (temperature 105 F.), 1 pint. 
Thoroughly mix. A piece of castile soap is then 
stirred about in this mixture to make a light lather. 
The whole, when thoroughly mixed, is at a temperature 
of ioo° F., which is suitable for the purpose. It should 
be injected as high into the bowel as possible through a 
large-sized, soft catheter or flexible tube, the finger being 
inserted into the bowel before the introduction of the 
tube. If the patient's pelvis be raised considerably it 
will assist in obtaining a good result. If care be used 
the patient should suffer no discomfort and should be 
able to retain the injection for several hours. 

The bowel is utilized oftentimes for feeding 
when the stomach is so disordered that it can- 
not digest food. Predigested milk or predi- 



THE CHILD. 247 

gested beef, combinations of eggs and milk, 
or other nutritious substances, may be injected 
into the bowel and thus absorbed. To do this 
properly requires experience and skill in nurs- 
ing, for the bowel must be thoroughly cleansed 
once or twice daily when such treatment is 
employed, and great care and gentleness are 
necessary to secure the retention of the injec- 
tions. A child should be turned upon its left 
side, its hips raised upon a folded blanket or 
pillow, the injection made by a fountain syringe 
or by a syringe working very smoothly, and 
the material introduced into the bowel through 
a soft rubber catheter carefully oiled and 
passed as high into the bowel as it will go. In 
this manner, if the child be urged not to strain, 
sufficient nourishment can be introduced to 
sustain the child for some time. In a des- 
perate case of pneumonia in an infant, with 
the aid of skilful nurses, the writer succeeded 
in feeding a child by injections into the bowel 
for a week. 

In cases of shock and hemorrhage much 
good may be done the patient by introducing 
into the bowel an abundant supply of saline 
solution. One teaspoonful of table-salt to a 
pint of warm water makes a solution which 
is exceedingly valuable where blood is lost 



248 MOTHER AND CHILD. 

or in some cases of severe disease. From 
four to six ounces of this may be introduced 
into the bowels of a child and allowed to be 
absorbed with great advantage, and this may 
be repeated at intervals of from two to three 
hours. 

In dysentery, injections of iced water are 
sometimes administered with excellent effect. 
The frequency and quantity of such injections 
should be governed by the express directions 
of the physician. 

The Destruction of Intestinal Parasites 
by Injection. 

Children are sometimes annoyed by para- 
sites in the intestine, just above the opening 
of the bowel. These resemble small bits of 
white thread or string, and by their constant 
motion they cause great irritation and distress. 
They are frequently treated by medicated in- 
jections. The bowels are usually emptied by 
laxative or purgative medicine, and then the 
rectum is thoroughly washed out with the 
medicinal preparation as the doctor directs. 
Usually such treatment is successful in 
promptly destroying the parasite. It is evi- 
dent that tape-worm, which lies in the upper 
part of the intestine, cannot be reached by 



THE CHILD. 249 

injection into the lower bowel ; hence the 
treatment of tape-worm is by the administra- 
tion of medicines through the mouth. 



CHAPTER XVI. 

ASEPSIS AND ANTISEPSIS. 

So valuable is our knowledge of asepsis 
and antisepsis in preventing diseases among 
children, as well as adults, that it is neces- 
sary that those who care for children should be 
informed upon the important facts of this sub- 
ject. Given pure food, pure water, and pure 
air, a large number of diseases which attack 
children would cease to affect them. It is of 
the utmost importance that these should be 
secured, if possible, for every child. Where 
injury to the body occurs, if nothing unclean 
touches the wound, Nature covers it by what 
is commonly called a "scab." This is a crust 
of dried blood, sometimes containing bits of 
clothing and dirt, but usually free from poison- 
ous germs. If this scab be not removed, the 
wound heals beneath it without inflammation. 
Hence, in minor wounds of children, Nature's 



250 MOTHER AND CHILD. 

dressing should not be removed. Where poi- 
sonous germs gain access to the body through 
a cut or wound, redness, swelling, and the for- 
mation of pus result. The wound is then in- 
fected. In cases where bacteria multiply in the 
intestines, in the lungs, in the urinary organs, 
or in the skin, the discharges from the body 
may contain germs and spread disease ; so the 
bowel movements of a child suffering from 
enteric fever in summer may poison water, 
and through it enter the bowels of another 
child, who is made ill. The mucus ejected 
from the lungs in whooping-cough or in 
measles contains germs which breathed in by 
another child occasion the disease. Discharges 
from the genito-urinary organs containing bac- 
teria may poison any portion of the mucous 
surface of the body in another patient. The 
perspiration from the skin and the scales 
which form when the skin dies after inflam- 
mation may convey germs to another child, 
and thus occasion disease. 

Asepsis. 

By asepsis we mean a condition in which 
poisonous germs are not present. Thus, ab- 
solutely pure water is in an aseptic condition. 
Surgical dressings which have been permeated 



THE CHILD. 251 

by heat and contain no germs are in an aseptic 
condition. The air of the sea or of the moun- 
tains is practically without germs and is asep- 
tic. In treating patients we are careful to use, 
so far as we can, aseptic fluids, aseptic food, 
and aseptic articles. In medical language, we 
practise asepsis. An aseptic substance cannot 
cause infection or contagion, because it con- 
tains no infectious or contagious germs. 

Antisepsis. 

It has been found so difficult to make arti- 
cles perfectly aseptic that, as an additional 
safeguard, we employ antiseptics. These are 
chemicals which poison and destroy bacteria. 
They are used in solutions and in powder, 
and are applied dissolved in water or upon 
surgical dressings. Some of them are so 
strong that they can poison a patient if im- 
properly used. Children are especially sus- 
ceptible to poisonous antiseptics, and hence 
physicians are careful to choose those milder 
substances whose use is practically without 
danger. 

Modern medicine has advanced to that point 
where patients have a right to demand that 
the principles of asepsis and antisepsis shall 
be followed in the treatment of their diseases. 



252 MOTHER AND CHILD. 

This is especially true with children, many of 
whose diseases can be prevented and others 
largely controlled by employing such knowl- 
edge. No method of treatment can be called 
scientific or modern which does not keep these 
facts constantly before the mind. 



CHAPTER XVII. 

INOCULATION. 

It has been found that substances produced 
by diseased germs, when passed through 
healthy animals, have in some cases the prop- 
erty of acting as antidotes for the original dis- 
ease in the human being. These substances 
are called antitoxines. They are obtained 
usually from horses by introducing into the 
blood of the animals some of the products of 
disease germs. The horse seems able to 
resist these poisons, and forms within his blood 
substances capable of destroying the germs 
of disease in the human species. The most 
brilliant success obtained by these remedies is 
seen in the use of antitoxin in diphtheria. By 
injecting into patients attacked with diphtheria 
this substance, the disease is checked, and in 



THE CHILD. 253 

the larger number of cases recovery begins 
immediately. In an epidemic of diphtheria 
children may be protected from the disease by 
injections of antitoxin. Antitoxin has also 
been successfully used for lockjaw ; and the 
time will probably come when other diseases 
caused by germs will be cured in the same 
manner. The introduction of any form of 
antitoxin to cure disease is termed " inocu- 
lation/ ' 

Vaccination. 

It was observed by Jenner and others that 
those who milked large numbers of cows 
during epidemics of smallpox in England had 
sores upon their hands which they contracted 
from ulcerations upon the udders of the ani- 
mals. These persons, however, escaped small- 
pox, while many who had not these sores upon 
their hands suffered from the disease. This 
led Jenner to take some of the matter from 
the sores upon the cow and to introduce it 
into the blood of human beings by rubbing it 
upon an open wounded spot. Persons thus 
inoculated with matter from the young cow — 
called " vaccine matter" — were vaccinated and 
did not have smallpox. If it is true that water 
puts out fire, then it is true that vaccination 
prevents smallpox. A human being vacci- 



254 MOTHER AND CHILD. 

nated properly once in five years is safe from 
smallpox. 

It is evident that only vaccine matter which 
is free from germs of inflammation should be 
used for vaccination ; hence the most reliable 
and clean vaccine matter must be employed. 
Care must also be taken that vaccination be 
done in an aseptic manner, that the needle or 
instrument used in wounding the skin be ster- 
ilized, and that the skin itself be cleansed and 
made as nearly sterile as possible, that clean 
linen be used about the site of vaccination, 
and that the hands of the vaccinator be thor- 
oughly clean. The vaccinated spot must be 
protected from irritation caused by the cloth- 
ing, and from the access of all impurities. 
Under these conditions vaccination may be 
successfully done upon children at any age 
and without causing serious inconvenience or 
illness. The writer has repeatedly vaccinated 
nursing infants without the slightest constitu- 
tional disturbance. 

On the other hand, unclean vaccination and 
lack of care in protecting the vaccinated spot 
from dirt and contamination may result in death 
from blood-poisoning or lockjaw. 

It is now thought best to cover the vac- 
cinated spot with a transparent shield, which 



THE CHILD. 255 

is worn until the spot has thoroughly dried 
and the reaction of vaccination begins. When 
a discharge occurs, the shield should be re- 
moved, the skin about the vaccinated spot 
thoroughly washed with warm water and soap, 
and then with alcohol, and a thoroughly clean 
dressing applied. Sterile gauze kept in place 
by a sterile bandage is needed to prevent irri- 
tation. Sterile or mildly antiseptic ointment 
may be spread upon the gauze. If the dress- 
ings be suitably applied and faithfully worn no 
serious result will follow vaccination. 

The question is often asked, " When shall 
vaccination be done?" Whenever danger of 
infection by smallpox arises. The age of a 
child has nothing to do with the question of 
vaccination. A child may be vaccinated the 
day it is born, if necessary, without especial 
danger. If vaccination be done upon the leg, 
and the reaction is vigorous, the child must 
be kept quiet for a day or two when the reac- 
tion is greatest. Even then serious inflamma- 
tion in properly treated cases does not occur. 



DIETARY. 



Albumin or White-of-Egg Water. 

Stir the whites of two eggs without heating into one- 
half pint of ice-water. Add enough salt or sugar to 

make palatable. 

Arrow-Root. 

Take one -pint of sweet milk ; let it come to the boil- 
ing point ; then mix two teaspoonfuls of arrow-root with 
enough cold water to form a thin paste, and add it to the 
hot milk. Let it boil for fifteen or twenty minutes, stir- 
ring to keep it from scorching. Season to taste. Arrow- 
root can be made with half milk and half water. 

Barley Water, — Gruel or Jelly. 

Wash two ounces of pearl barley with cold water. 
Boil for five minutes in fresh water ; throw both waters 
away. Pour on two quarts of boiling water ; boil down 
to a quart. Strain (if patient desires), and flavor with 
thinly-cut lemon-rind. Add sugar to taste. 

To make jelly, put two tablespoonfuls of washed pearl 
barley into a saucepan with one and one-half pints of 
water. Boil slowly down to a pint. Strain, and allow 
liquid to set into a jelly. 

Another way to make barley gruel : Take one-half pint 
of barley jelly, add one-half pint of milk. Boil slowly 
for twenty minutes. A little salt will improve taste. 

Another way to make barley jelly : Take six table- 
spoonfuls of pearl barley, wash thoroughly; add one 
256 



DIETARY. 257 

quart of cold water, and boil slowly for three hours; 
then press the grain thoroughly through a fine strainer. 
This should make one-half pint of jelly. An agate or 
porcelain-lined boiler should be used. 

Beef-juice. 

Cut a thin, juicy steak into pieces one and one-half 
inches square, and brown separately one and one-half 
minutes in a frying pan. Force through a hot meat 
squeezer or lemon squeezer, and flavor with salt and 
pepper. May be served hot or cold. 

Beef Sandwich (Scraped). 

Scrape pulp from a good steak, season to taste, and 
spread thinly on thin slices of buttered (slightly) bread. 

Beef Tea. 

One pound of steak from top of round, one pint of 
cold water, salt. Wipe the steak, remove all fat, and 
cut into small pieces. Soak for three hours in the cold 
water ; then place on back of range for one hour, care 
being taken that the heat is not sufficient to coagulate the 
juices. Strain, season, and reheat ; same care in regard 
to heating juices as before. 

Chicken Broth. 

Dress and clean a chicken. Remove skin and fat, dis- 
joint, and wipe with a wet cloth. Put into kettle with 
one and a half quarts of cold water; heat to boiling 
point. Skim, and cook slowly until meat is tender. 
When half done, add one and one-half teaspoonfuls of 
salt and a few grains of pepper. Cool thoroughly and 
skim fat. Reheat and serve. 

17 



258 DIETARY. 

Clam Broth. 

Wash thoroughly six large clams in the shell ; put in 
kettle with one cup of water ; bring to a boil, and keep 
there one minute ; the shells open, the water takes up 
the proper quantity of juice, and the broth is ready to 
pour off and serve hot. 

Mutton Broth. 

Add one pound of loin of mutton to three pints of 
cold water; boil slowly until very tender, adding one 
teaspoonful of salt when half done. Strain, and when 
cold skim off fat. Three tablespoonfuls office or the 
same amount of barley added makes it more palatable. 

Oyster Broth. 

To one dozen oysters, with liquor, add one cup of cold 
water. Let it come to a boil, and boil for five minutes. 
Strain and season. 

Veal Broth. 

Mince one-half to one pound of lean veal ; pour over 
it a pint of cold water. Let it stand for three hours, 
then slowly heat to boiling point. After boiling briskly 
for two minutes strain through a fine sieve and season 
with salt. 

Buttermilk. 

Buttermilk should be prepared from good, pure cream 
by a churning process. After the butter is formed, the 
milk should be strained and kept well covered in a cool 
place. 



DIETARY. 259 

Corn Gruel. 

Two tablespoonfuls of Indian meal, one tablespoonful 
of flour, one-half teaspoonful of salt, three cups of boil- 
ing water. Mix the meal, flour, and salt. Add enough 
cold water to make a thin paste. Add to boiling water, 
and boil gently one hour. Dilute with milk or cream. 
A richer gruel may be made by using milk instead of 
water and cooking three hours in double boiler. 

Egg and Lemon. 

Beat one egg with one tablespoonful of sugar until 
very light. Add three tablespoonfuls of cold water and 
the juice of a small lemon. Put in a glass with pounded 
ice and drink through a straw. 

Egg and Milk. 

Beat milk with salt to taste. Beat white of egg until 
stiff, add egg and milk, and stir. 

Eggnog with Stimulant. 

Make mixture same as for plain eggnog and pour over 
it one tablespoonful of wine or brandy diluted with same 
quantity. Shake well and serve at once. 

Eggnog without Stimulant. 

Beat an egg slightly and add one teaspoonful of sugar 
and a few grains of salt. To this add one glass of milk. 
Mix thoroughly and strain. A slight grating of nutmeg, 
if desired. 

Enemata (Nutrient) Containing Milk. 

Peptonize the milk by the warm process, then add 
whatever other ingredients the physician may order. 



260 DIETARY. 

Flaxseed Tea. 

Remove the black specks from two tablespoonfuls of 
whole flaxseed. Add to it one heaping tablespoonful of 
white sugar and a little lemon-juice. Pour on these 
materials one quart of boiling water. Let it stand in a 
hot place for four hours. Strain and serve either hot or 
cold. 

Hominy Jelly, 

One-half cup of fine hominy added to one quart of 
boiling water and one-half teaspoonful of salt. Cook in 
double boiler down to one pint. Time, three hours 
usually. 

Junket. 

One cup of milk, one tablespoonful of sugar, one table- 
spoonful of sherry wine, one teaspoonful of liquid rennet. 
Heat milk until lukewarm ; add sugar and wine ; when 
sugar is dissolved add rennet. Turn into a small mould 
and let it stand in a cool place until firm. Serve with 
sugar and cream. For flavoring, cinnamon or nutmeg 
may be used in place of wine. 

Kumiss. 

One quart of milk, one and one-half tablespoonfuls of 
sugar, one-third of a yeast-cake dissolved in one table- 
spoonful of lukewarm water. Take ordinary beer-bottles 
with shifting corks. Heat milk until lukewarm ; add 
sugar and dissolve yeast-cake. Fill bottles to within one 
and one -half inches of top; cork and invert. Let it 
stand for six hours at a temperature of 80 ° F. Place 
on ice, and use after twelve hours. Much waste can be 



DIETARY. 261 

saved by preparing the bottles with ordinary corks wired 

in position and drawing off the kumiss with a champagne 

tap. 

Milk Peptonized. 

Cold Process. — Into a clean quart bottle put one pep- 
tonizing powder (extract of pancreas, five grains ; sodium 
bicarbonate, 15 grains) or the contents of one pepton- 
izing tube (Fairchild). Add one teacupful of cold water 
and shake ; add one pint of fresh, cold milk, and shake 
mixture again. Pack bottle in ice, and use when 
required without subjecting to heat. 

Warm Process. — Mix peptonizing powder with water 
and milk as described above ; place bottle in water so 
warm that the entire hand can be held in it for a minute 
without discomfort. Keep bottle there ten minutes, 
and then pack in ice. 

Milk Punch. 

One cup of milk, one teaspoonful of sugar, one tea- 
spoonful of brandy, a few grains of salt. Dilute brandy 
with water (one tablespoonful), add sugar and salt, then 
milk. Shake thoroughly, serve at once. 

Oatmeal Water, — Gruel or Jelly. 

One cup of fine oatmeal, two quarts of water (which 
has been boiled and cooled). Add oatmeal to water, 
and keep in a warm place (at a temperature of 80 ° F. ) 
one and one-half hours. Strain and cool. 

Gruel. — One-half cup of coarse oatmeal, three cups 
of boiling water, one teaspoonful of salt. Add oatmeal 
and salt to boiling water, and cook in a double boiler 
three hours. Force through a strainer, and dilute with 
milk or cream. Reheat and season. 



262 DIETARY. 

Puree of Celery. 

Take six large stalks of celery, wash and clean thor- 
oughly, add enough water to cover the celery, let it boil 
until quite soft, press through a fine strainer, and boil the 
liquor again for a short time. Then strain again and add 
one pint of milk, two small teaspoonfuls of arrow-root 
mixed with cold water, a little salt. Boil for twenty 
minutes additional. 

Puree of Carrots. 

To the liquor in which a knuckle of veal has been 
boiled add twelve large carrots. Boil until the carrots 
will mash through a sieve. Put them through, and then 
let them boil in the broth until it is quite smooth. Add 
one-half pint of cream and a little salt. 

Puree of Corn. 

Take six large ears of corn, grate them, and add one 
pint of water. Let boil slowly one hour, stirring fre- 
quently to keep from sticking. Strain through fine 
strainer, pressing out all the liquid. To the liquid add 
one pint of milk, two small teaspoonfuls of arrow-root, a 
little salt, and boil twenty minutes. 

Puree of Lima Beans. 

Take one quart of lima beans, add one quart of cold 
water ; boil until quite soft ; then press through fine 
strainer. To this add one pint of milk, one small tea- 
spoonful of arrow-root mixed with cold water, and salt to 
taste. Boil for fifteen or twenty minutes. 



DIETARY. 263 

Puree of Peas. 

To one pint of fresh peas add three pints of water. 

Boil until quite soft, then press through strainer. To 

this add one pint of milk, one small teaspoonful of 

arrow-root and a little salt, and boil fifteen or twenty 

minutes. 

Puree of Spinach. 

Three handfuls of spinach, one quart of milk, one-half 
pint of cream, one tablespoonful of butter, and a small 
tablespoonful of flour; pepper and salt. Wash spinach 
clean, and boil in plenty of water with a little salt. 
When thoroughly cooked, strain from the water and 
mash the spinach through a fine wire sieve. Heat the 
butter, and mix the flour in the hot butter until perfectly 
smooth. Add milk and cream. Then put the spinach 
into the milk and serve very hot. If a richer soup is 
needed, take less milk and more cream. 

(In spite of the care taken to indicate proportions for 
purees, it is almost impossible to give the exact propor- 
tions, because certain vegetables are much more easily 
thickened than others. Therefore it is advisable, if the 
puree becomes too thick, to add a little more water or 
bouillon in which the vegetable was boiled. If there is 
no more of this, then add simply a small quantity of 
boiling water, taking care never to go beyond one quart 
of liquid, as with the proportion of vegetables given that 
is sufficient for four adults. ) 

Rice Water, — Gruel or Jelly. 

Pick over and wash two tablespoonfuls of rice. Add 
two cups of cold water and boil until the rice is soft. 



264 DIETARY. 

Strain, and add milk or cream if desired. Reheat and 
season with salt. 

Prepare gruel or jelly as pearl barley. 



Another Way to Make Rice Gruel. 

Take one-half pint of rice jelly ; add one-half pint of 
milk. A little salt or sugar will improve taste. Boil 
twenty minutes, being careful not to scorch. 



Another Way to Make Rice Jelly. 

Take four tablespoonfuls of rice, wash thoroughly. 
Add one quart of water, boil slowly until the rice is 
quite soft and strain through a fine strainer, pressing the 
grains well through the strainer. Rice is best boiled in a 
double boiler. 

Toast Water. 

Equal measures of stale bread, toasted, and boiling 
water. Cut the bread in inch slices, put in pan, and dry 
thoroughly in a slow oven until crisp and brown. Break 
in pieces, add water, and let stand one hour. Strain 
through cheese-cloth and season. Serve hot or cold. 



Wheat Water, — Gruel or Jelly. 

Using the entire wheat, prepare the same as barley 
water. 

Gruel. — One tablespoonful of flour, two cups of milk, 
pinch of salt. Mix flour with one-fourth cup of milk. 
Scald remaining milk in double boiler, add flour paste, 
and cook thirty minutes. Season. 



JUL 



JUL 



5 1902 



loon L>t.t ^ 5 ; 

JUL. 5 1902 



JUL 19 19Q2 



